Active NPI
Raisa Shams
- Mental Health Counselor
- Atlantic Highlands, NJ
National Provider Identifier
1821545641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1041 Highway 36 Ste 206
Atlantic Highlands, NJ 07716 - Phone
- (732) 982-2888
- NPI assigned
- Sep 9, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1041 Highway 36 Ste 206
Atlantic Highlands, NJ 07716
Mailing address
500 N Bridge St
Bridgewater, NJ 08807-2135
Phone (908) 725-2800
Other practice location 1
500 N Bridge St
Bridgewater, NJ 08807-2135
Phone (908) 725-2800 ext. 3016
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0023701 | Other | NJ | AGENCY MEDICAID |
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PHC of Buffalo Grove Clinical Psychology | Past | Accepting new patients |
Interoperability endpoints
- lifestancehealth.raisashams@148376.advancedmd-direct.com
Organizations & group practices 1
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.
-
- Psychologist
- Vernon Hills, IL
- NPI 1235430612
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531958400000",
"number": "1821545641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 N BRIDGE ST",
"city": "BRIDGEWATER",
"state": "NJ",
"postal_code": "088072135",
"telephone_number": "908-725-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1041 HIGHWAY 36 STE 206",
"city": "ATLANTIC HIGHLANDS",
"state": "NJ",
"postal_code": "07716",
"telephone_number": "732-982-2888"
}
],
"practiceLocations": [
{
"address_1": "500 N Bridge St",
"address_purpose": "LOCATION",
"city": "Bridgewater",
"state": "NJ",
"postal_code": "088072135",
"country_code": "US",
"telephone_number": "908-725-2800 x3016",
"fax_number": "908-704-1790",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHAMS",
"first_name": "RAISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-09",
"last_updated": "2018-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY MEDICAID",
"identifier": "0023701",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlantic Highlands, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.