Kenneth Louis Shore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C003006 Issued in NC

Practice address

4112 Blue Ridge Road
2ND Floor
Raleigh, NC 27612-4652

Phone

(919) 573-6520

Fax

(919) 573-6557

NPI assigned

Feb 26, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Carolina Counseling & Consultation Services

  • Mental Health Counselor
  • Smithfield, NC
  • NPI 1902859333
  NPD (past)
• Psimed PA

  • Psychiatry Physician
  • Clemmons, NC
  • NPI 1366613663
  NPD (past)

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203984000000",
    "number": "1871762641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 BLACKSTONE VALLEY PLACE",
            "address_2": "SUITE 300 FELLOWSHIP HEALTH RESOURCES INC",
            "city": "LINCOLN",
            "state": "RI",
            "postal_code": "028651163",
            "telephone_number": "401-333-3980",
            "fax_number": "401-333-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 BLUE RIDGE ROAD",
            "address_2": "2ND FLOOR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124652",
            "telephone_number": "919-573-6520",
            "fax_number": "919-573-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "KENNETH",
        "middle_name": "LOUIS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C003006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monika Rae Shontz, LCSWA
• Sara Ann Shook-Rosen, LCMHC, LCAS, CCS
• Heather Danae Shoopman, OT/R
• Anna Lewis Shope, DDS
• Samantha G Shopovick, AU-D
• Douglas B Short, MD
• Showers of Blessings LLC
• Showersofblessings LLC
• Showtime Mentors
• Mary Paige Shrader

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.