Shannon Grace Brockert

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801102228 Issued in MI

Practice address

30101 Hoover Rd
Warren, MI 48093-6572

Phone

(586) 558-6868

NPI assigned

Feb 26, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

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 and National Provider Directory roles.

• Imagine Counseling

  • Community/Behavioral Health Agency
  • Saint Clair Shores, MI
  • NPI 1063076008
  NPD (past) Authorized official

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

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1750882668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20601 YALE ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811779",
            "telephone_number": "586-460-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30101 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480936572",
            "telephone_number": "586-558-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKERT",
        "first_name": "SHANNON",
        "middle_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-26",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801102228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Ann Brigolin, OTRL
• Jill Brinker, OTR
• Renee Victoria Brinn, MT-BC
• Tiffany Chantell Brintley
• Brite Home Health Care LLC
• Mary Brockman
• Anemaecore Abadejos Brodith, PHYSICAL THERAPIST
• Meghan Brodsky, D.D.S.
• Nicholas Joseph Brosky, MSOT, OTRL
• Adanna Brown

• Clinical Social Worker in Warren, MI
• Providers in Warren, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.