Kelly Grace Shaw

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27718 Issued in MD

Practice address

757 Whitneys Landing Dr
Crownsville, MD 21032-1113

Phone

(443) 420-8073

NPI assigned

Aug 21, 2019

Last updated

Apr 2, 2025By the provider in NPPES

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

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MD

  Medicare reassignment NPD

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1780231100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "757 WHITNEYS LANDING DR",
            "city": "CROWNSVILLE",
            "state": "MD",
            "postal_code": "210321113",
            "telephone_number": "443-789-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 WHITNEYS LANDING DR",
            "city": "CROWNSVILLE",
            "state": "MD",
            "postal_code": "210321113",
            "telephone_number": "443-420-8073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KELLY",
        "middle_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-21",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "27718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Second Genesis, Inc.
• David Semanco, MAC,CADC,CSAC,CAC-AD
• Serenity Acres Treatment Center LLC
• John Peter Serlemitsos, MD
• Sharkey Pediatric Occupational Therapy
• Jinell Anne Smithmyer, LAC
• Gwinn Alene Spence, LGCP, CAC-AD
• Robert Jay Stern, MD
• Katherine Spohn Streett
• Ernestine Suggs, LCPC

• Clinical Social Worker in Crownsville, MD
• Providers in Crownsville, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.