Shannyn S Vicente, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

64962 Issued in TX

Practice address

5108 Broadway Ste 220
San Antonio, TX 78209-5728

Phone

(210) 501-9869

NPI assigned

May 7, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Inbodied

  • Clinical Social Worker
  • San Antonio, TX
  • NPI 1205535226
  Medicare reassignment NPD Authorized official
• And Breathe,LLC

  • Clinical Social Worker
  • Portland, ME
  • NPI 1275892689
  NPD (past) Authorized official

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1962761361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 BROADWAY STE 220",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782095728",
            "telephone_number": "210-501-9869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5108 BROADWAY STE 220",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782095728",
            "telephone_number": "210-501-9869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICENTE",
        "first_name": "SHANNYN",
        "middle_name": "S",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-07",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC13577",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "64962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vibrant Eyecare, PLLC
• Brian Peter Vicari, MD
• Vicdos Health LLC
• Vicente a Rodriguez MD PA (Respiratory Center of South Texas)
• Gabrielle Alexis Quismundo Vicente, DDS
• Stefany Michelle Vicente, MD
• Connie Elizabeth Vick, APRN, FNP-C
• Morgan Amanda Vick, BCBA
• Sammy C. Vick, M.D.
• Vickers Corp. (ComForcare Senior Services-West Bexar County)

• Clinical Social Worker in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.