Individual provider Active NPI

Shelley Lynn Palmer-Burgess, LCSW

  • Clinical Social Worker
  • Bangor, ME
National Provider Identifier
1821022336
Registry record updated Sep 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC3835 Issued in ME
Practice address
15 Columbia St
Bangor, ME 04401-6355
Phone
(207) 262-3500
Fax
(207) 262-3501
NPI assigned
Jul 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC3835 ME Primary

Addresses

Primary practice location

15 Columbia St
Bangor, ME 04401-6355

Mailing address

15 Columbia St
Bangor, ME 04401-6355
Phone (207) 262-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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

Enrollment IDStateProvider typePAC IDDetails
I20041018000609 ME Practitioner - Clinical Social Worker 3779543319 Practice locations: Bangor, ME

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316563200000",
    "number": "1821022336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 COLUMBIA ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016355",
            "telephone_number": "207-262-3500",
            "fax_number": "207-262-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 COLUMBIA ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016355",
            "telephone_number": "207-262-3500",
            "fax_number": "207-262-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER-BURGESS",
        "first_name": "SHELLEY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2011-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC3835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.