Active NPI
Shelley Lynn Maryott-Moore, LICSW, GMHS, CMHS
- Clinical Social Worker
- Longview, WA
National Provider Identifier
1720103708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW00007954
- Practice address
- 921-14TH Ave.
Longview, WA 98632 - Phone
- (360) 423-0203
- Fax
- (360) 423-2311
- NPI assigned
- Mar 20, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW00007954 | WA | Primary |
Addresses
Primary practice location
921-14TH Ave.
Longview, WA 98632
Mailing address
Lower Columbia Mental Health/Ccga
921-14TH Avenue
Longview, WA 98632
Phone (360) 423-0203
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LW00007954 | Other | WA | LICSW |
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 |
|---|---|---|---|
| LW00007954 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720103708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "LOWER COLUMBIA MENTAL HEALTH/CCGA",
"address_2": "921-14TH AVENUE",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "98632",
"telephone_number": "360-423-0203",
"fax_number": "360-423-2311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921-14TH AVE.",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "98632",
"telephone_number": "360-423-0203",
"fax_number": "360-423-2311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARYOTT-MOORE",
"first_name": "SHELLEY",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "LICSW, GMHS, CMHS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW00007954",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICSW",
"identifier": "LW00007954",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.