Joseph Timothy Shanly, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

064470 Issued in NY

Practice address

32735 County Route 29 Ste a
Philadelphia, NY 13673-4210

Phone

(315) 642-3142

Fax

(315) 642-3249

NPI assigned

Nov 17, 2010

Last updated

Nov 17, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Lawrence Psychiatric Center

  • Psychiatric Hospital
  • Philadelphia, NY
  • NPI 1730480179
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289952000000",
    "number": "1629370069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 MYRTLE AVE",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014601",
            "telephone_number": "315-783-9114",
            "fax_number": "315-642-3249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32735 COUNTY ROUTE 29 STE A",
            "city": "PHILADELPHIA",
            "state": "NY",
            "postal_code": "136734210",
            "telephone_number": "315-642-3142",
            "fax_number": "315-642-3249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANLY",
        "first_name": "JOSEPH",
        "middle_name": "TIMOTHY",
        "name_prefix": "Mr.",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-17",
        "last_updated": "2010-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "064470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730480179",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gouverneur Family Health NP
• Indian River Ambulance Service Inc
• Indian River Central School District
• Erin Ashley Kiechle, LMHC
• Mirza M Ashraf & Mulazim H Khan (Philadelphia Medical Center)
• Alexis Catherine Shippee, PT, DPT
• Catherine Ann Slocum-Bell, MS, CCC
• St Lawrence Psychiatric Center
• Thomas P. McCue IV DDS PC
• Frederick G Tontarski, PA

• Clinical Social Worker in Philadelphia, NY
• Providers in Philadelphia, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.