Active NPI
Shannon Lewis, PSY.D.
- Clinical Psychologist
- Stoughton, MA
National Provider Identifier
1811206121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 9667
- Practice address
- 450 Pearl St Ste 3
Stoughton, MA 02072-1617 - Phone
- (781) 318-3177
- NPI assigned
- Oct 4, 2010
- 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 Psychologist | 103TC0700X | 9667 | MA | Primary |
Addresses
Primary practice location
450 Pearl St Ste 3
Stoughton, MA 02072-1617
Mailing address
450 Pearl St Ste 3
Stoughton, MA 02072-1617
Phone (781) 318-3177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 8, 2025 through Jul 8, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9667 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644192000000",
"number": "1811206121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 PEARL ST STE 3",
"city": "STOUGHTON",
"state": "MA",
"postal_code": "020721617",
"telephone_number": "781-318-3177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 PEARL ST STE 3",
"city": "STOUGHTON",
"state": "MA",
"postal_code": "020721617",
"telephone_number": "781-318-3177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "SHANNON",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-04",
"last_updated": "2022-02-07",
"certification_date": "2022-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "9667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stoughton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.