Active NPI
Shelley Alane Theriault, LMSW
- Clinical Social Worker
- Machias, ME
National Provider Identifier
1740526953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- MC13939
- Practice address
- 15 Kids Cor
Machias, ME 04654-3328 - Phone
- (207) 255-8473
- NPI assigned
- Dec 14, 2012
- 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 | MC13939 | ME | Primary |
Addresses
Primary practice location
15 Kids Cor
Machias, ME 04654-3328
Mailing address
530 Route 1
Pembroke, ME 04666-4425
Phone (207) 214-0255
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 |
|---|---|---|---|
| MC13939 | ME | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355443200000",
"number": "1740526953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 ROUTE 1",
"city": "PEMBROKE",
"state": "ME",
"postal_code": "046664425",
"telephone_number": "207-214-0255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 KIDS COR",
"city": "MACHIAS",
"state": "ME",
"postal_code": "046543328",
"telephone_number": "207-255-8473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THERIAULT",
"first_name": "SHELLEY",
"middle_name": "ALANE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-14",
"last_updated": "2012-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "MC13939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Machias, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.