Ellen Shaw-Smith Licsw BCN, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

113030 Issued in MA

Legal business name

ELLEN SHAW-SMITH LICSW BCN, LLC

Practice address

104 Russell St
Hadley, MA 01035-9570

Phone

(413) 582-0355

Fax

(413) 582-0411

NPI assigned

Dec 13, 2017

Last updated

Dec 13, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Ellen Michelle Shaw-Smith, LICSW BCNNPI 1427073725

Title

Solo Clinical Social Worker

Phone

(413) 582-0355

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellen Michelle Shaw-Smith, LICSW

  • Clinical Social Worker
  • Northampton, MA
  • NPI 1427073725
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513123200000",
    "number": "1891200770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 622",
            "city": "HADLEY",
            "state": "MA",
            "postal_code": "010350622",
            "telephone_number": "413-582-0355",
            "fax_number": "413-582-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 RUSSELL ST",
            "city": "HADLEY",
            "state": "MA",
            "postal_code": "010359570",
            "telephone_number": "413-582-0355",
            "fax_number": "413-582-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN SHAW-SMITH LICSW BCN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2017-12-13",
        "status": "A",
        "authorized_official_last_name": "SHAW-SMITH",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "SOLO CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "413-582-0355",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICSW  BCN"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MA",
            "license": "113030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110081474A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Hadley, MA
• Providers in Hadley, MA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.