Active NPI
Regina Shannon
- Clinical Social Worker
- Riverside, RI
National Provider Identifier
1710376827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ISW02919
- Practice address
- 1011 Veterans Memorial Pkwy
Riverside, RI 02915 - Phone
- (401) 432-1000
- Fax
- (401) 432-1500
- NPI assigned
- Jan 13, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | ISW02919 | RI | Primary |
| Clinical Social Worker | 1041C0700X | CSW1778 | RI |
Addresses
Primary practice location
1011 Veterans Memorial Pkwy
Riverside, RI 02915
Mailing address
117 Ellenfield St Ste 101
Providence, RI 02905-4513
Phone (401) 724-8400
Other practice location 1
1011 Veterans Memorial Pkwy
Riverside, RI 02915
Phone (401) 432-1000
Other practice location 2
1471 Elmwood Ave
Cranston, RI 02910-3849
Phone (401) 724-8400 ext. 237
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GH57134 | Medicaid | RI |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW1778 | RI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553817600000",
"number": "1710376827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 ELLENFIELD ST STE 101",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029054513",
"telephone_number": "401-724-8400",
"fax_number": "401-722-5280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 VETERANS MEMORIAL PKWY",
"city": "RIVERSIDE",
"state": "RI",
"postal_code": "02915",
"telephone_number": "401-432-1000",
"fax_number": "401-432-1500"
}
],
"practiceLocations": [
{
"address_1": "1011 Veterans Memorial Pkwy",
"address_purpose": "LOCATION",
"city": "Riverside",
"state": "RI",
"postal_code": "02915",
"country_code": "US",
"telephone_number": "401-432-1000",
"fax_number": "401-432-1500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1471 Elmwood Ave",
"address_purpose": "LOCATION",
"city": "Cranston",
"state": "RI",
"postal_code": "029103849",
"country_code": "US",
"telephone_number": "401-724-8400 x237",
"fax_number": "401-722-5280",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHANNON",
"first_name": "REGINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-13",
"last_updated": "2019-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "ISW02919",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "CSW1778",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GH57134",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverside, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.