Active NPI
Shannon Alyse Randolph, MSW, LICSW
- Clinical Social Worker
- Roxbury, MA
National Provider Identifier
1821767922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW1121000
- Practice address
- 504 Dudley St
Roxbury, MA 02119-2732 - Phone
- (617) 445-6655
- NPI assigned
- Sep 10, 2021
- 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 | LICSW1121000 | MA | Primary |
Addresses
Primary practice location
504 Dudley St
Roxbury, MA 02119-2732
Mailing address
1 BMC Place
Moakley Connector Office 1301
Boston, MA 02118
Phone (617) 638-7147
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW1121000 | MA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Services of Roxbury | Current | Accepting new patients |
Locations
504 Dudley St
Roxbury, MA 02119
Phone (617) 445-6655
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.
-
- Mental Health Counselor
- Roxbury, MA
- NPI 1669107678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746489600000",
"number": "1821767922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BMC PLACE",
"address_2": "MOAKLEY CONNECTOR OFFICE 1301",
"city": "BOSTON",
"state": "MA",
"postal_code": "02118",
"telephone_number": "617-638-7147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 DUDLEY ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021192732",
"telephone_number": "617-445-6655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "SHANNON",
"middle_name": "ALYSE",
"name_prefix": "Miss",
"credential": "MSW, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-10",
"last_updated": "2025-05-06",
"certification_date": "2025-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LICSW1121000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.