Active NPI
Shanae Aisha Gardner, LCSW-C
- Clinical Social Worker
- Baltimore, MD
National Provider Identifier
1649823428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 18973
- Practice address
- 3716 Chesholm Rd Unit B
Baltimore, MD 21216-2413 - Phone
- (667) 231-1187
- NPI assigned
- Jul 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 18973 | MD | Primary |
Addresses
Primary practice location
3716 Chesholm Rd Unit B
Baltimore, MD 21216-2413
Mailing address
3716 Chesholm Rd
Baltimore, MD 21216-2413
Phone (667) 231-1187
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18973 | MD | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Village Therapeutic Services, LLC | Clinical | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Baltimore, MD
- NPI 1518642792
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655424000000",
"number": "1649823428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3716 CHESHOLM RD",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212162413",
"telephone_number": "667-231-1187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3716 CHESHOLM RD UNIT B",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212162413",
"telephone_number": "667-231-1187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "SHANAE",
"middle_name": "AISHA",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-19",
"last_updated": "2022-06-17",
"certification_date": "2022-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "18973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.