Judy Vittum Shoupe, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005696 Issued in GA

Practice address

2403 Osler CT Ste B
Albany, GA 31707-0205

Phone

(229) 639-3135

Fax

(229) 639-3141

NPI assigned

Jun 20, 2016

Sex

Female

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

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1922458009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 N WESTOVER BLVD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317072983",
            "telephone_number": "229-888-6559",
            "fax_number": "229-436-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 OSLER CT STE B",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317070205",
            "telephone_number": "229-639-3135",
            "fax_number": "229-639-3141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Johnson St SE",
            "address_purpose": "LOCATION",
            "city": "Dawson",
            "state": "GA",
            "postal_code": "398421523",
            "country_code": "US",
            "telephone_number": "229-995-2990",
            "fax_number": "229-995-2993",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "204 N Westover Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "GA",
            "postal_code": "317072983",
            "country_code": "US",
            "telephone_number": "229-888-6559",
            "fax_number": "229-436-4107",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2100 Palmyra Rd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "GA",
            "postal_code": "317011320",
            "country_code": "US",
            "telephone_number": "229-888-3636",
            "fax_number": "229-888-5535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2202 E Oglethorpe Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "GA",
            "postal_code": "317052940",
            "country_code": "US",
            "telephone_number": "229-431-1423",
            "fax_number": "229-438-0738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOUPE",
        "first_name": "JUDY",
        "middle_name": "VITTUM",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Albany, GA
• Providers in Albany, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; 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.