Active NPI
Cherrelle N Shorter, LCSW
- Clinical Social Worker
- Clarksdale, MS
National Provider Identifier
1821582289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 677M
- Practice address
- 800 Ohio Ave
Clarksdale, MS 38614-7200 - Phone
- (662) 624-2504
- Fax
- (662) 627-3629
- NPI assigned
- Jun 19, 2018
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 677M | AR | Primary |
Addresses
Primary practice location
800 Ohio Ave
Clarksdale, MS 38614-7200
Mailing address
PO Box 1216
Clarksdale, MS 38614-1216
Phone (662) 624-4292
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 |
|---|---|---|---|
| 677M | AR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590969600000",
"number": "1821582289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1216",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "386141216",
"telephone_number": "662-624-4292",
"fax_number": "662-624-4354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 OHIO AVE",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "386147200",
"telephone_number": "662-624-2504",
"fax_number": "662-627-3629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORTER",
"first_name": "CHERRELLE",
"middle_name": "N",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-19",
"last_updated": "2020-06-01",
"certification_date": "2020-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AR",
"license": "677M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksdale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.