Active NPI
Christopher Mark Shea
- Clinical Social Worker
- New York, NY
National Provider Identifier
1972048544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 089479
- Practice address
- 303A W 21St St Apt 1W
New York, NY 10011-3076 - Phone
- (646) 460-3101
- NPI assigned
- Jan 5, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 089479 | NY | Primary |
Addresses
Primary practice location
303A W 21St St Apt 1W
New York, NY 10011-3076
Mailing address
303A W 21St St
1W
New York, NY 10011-3003
Phone (646) 460-3101
Other practice location 1
80 5th Ave Fl 9
New York, NY 10011-8002
Phone (646) 460-3101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 28, 2024 through Aug 28, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089479 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682121600000",
"number": "1972048544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303A W 21ST ST",
"address_2": "1W",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100113003",
"telephone_number": "646-460-3101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303A W 21ST ST APT 1W",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100113076",
"telephone_number": "646-460-3101"
}
],
"practiceLocations": [
{
"address_1": "80 5th Ave Fl 9",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100118002",
"country_code": "US",
"telephone_number": "646-460-3101",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHEA",
"first_name": "CHRISTOPHER",
"middle_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-05",
"last_updated": "2023-04-22",
"certification_date": "2023-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "089479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.