Active NPI
Shannon Cara Tracey, LCSW
- Clinical Social Worker
- Indianapolis, IN
National Provider Identifier
1780240556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34007707A
- Practice address
- 720 Eskenazi Ave
Indianapolis, IN 46202-5187 - Phone
- (317) 880-6629
- Fax
- (317) 880-0332
- NPI assigned
- May 16, 2019
- 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 | 34007707A | IN | Primary |
Addresses
Primary practice location
720 Eskenazi Ave
Indianapolis, IN 46202-5187
Mailing address
720 Eskenazi Ave
Indianapolis, IN 46202-5187
Phone (317) 880-6629
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 |
|---|---|---|---|
| 34007707A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557964800000",
"number": "1780240556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 ESKENAZI AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025187",
"telephone_number": "317-880-6629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 ESKENAZI AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025187",
"telephone_number": "317-880-6629",
"fax_number": "317-880-0332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACEY",
"first_name": "SHANNON",
"middle_name": "CARA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-16",
"last_updated": "2019-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34007707A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.