Active NPI
Jillien Amensie Shaw
- Mental Health Counselor
- Tuckahoe, NY
National Provider Identifier
1912605635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- P119122
- Practice address
- 92 Yonkers Ave
Tuckahoe, NY 10707-3911 - Phone
- (914) 337-6033
- Fax
- (914) 337-7218
- NPI assigned
- Feb 21, 2023
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | P119122 | NY | Primary |
Addresses
Primary practice location
92 Yonkers Ave
Tuckahoe, NY 10707-3911
Mailing address
20 Chadsford LN
Newburgh, NY 12550-8727
Phone (845) 857-4945
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 153143259 | Other | NY | DRIVERS LICENSE |
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 |
|---|---|---|---|
| P119122 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676937600000",
"number": "1912605635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 CHADSFORD LN",
"city": "NEWBURGH",
"state": "NY",
"postal_code": "125508727",
"telephone_number": "845-857-4945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "92 YONKERS AVE",
"city": "TUCKAHOE",
"state": "NY",
"postal_code": "107073911",
"telephone_number": "914-337-6033",
"fax_number": "914-337-7218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "JILLIEN",
"middle_name": "AMENSIE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-21",
"last_updated": "2023-02-21",
"certification_date": "2023-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "P119122",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "153143259",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tuckahoe, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.