NPIMap

Individual provider Active NPI

Michael Shepherd, LCSW

  • Clinical Social Worker
  • St. Albans, NY
National Provider Identifier
1982148094
Registry record updated Dec 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
084926-1 Issued in NY
Practice address
179-00 Linden Blvd. BLDG 91 RM E241
St. Albans E.C.C./Dept. of VA
St. Albans, NY 11425
Phone
(347) 534-6898
NPI assigned
Dec 8, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 084926-1 NY Primary

Addresses

Primary practice location

179-00 Linden Blvd. BLDG 91 RM E241
St. Albans E.C.C./Dept. of VA
St. Albans, NY 11425

Mailing address

179-00 Linden Blvd. BLDG 91 RM E241
St. Albans E.C.C./Dept. of VA
St. Albans, NY 11425
Phone (347) 534-6898

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

LicenseStateTypeSpecialty
084926-1NYMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1481155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1982148094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179-00 LINDEN BLVD. BLDG 91 RM E241",
            "address_2": "ST. ALBANS E.C.C./DEPT. OF VA",
            "city": "ST. ALBANS",
            "state": "NY",
            "postal_code": "11425",
            "telephone_number": "347-534-6898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179-00 LINDEN BLVD. BLDG 91 RM E241",
            "address_2": "ST. ALBANS E.C.C./DEPT. OF VA",
            "city": "ST. ALBANS",
            "state": "NY",
            "postal_code": "11425",
            "telephone_number": "347-534-6898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-12-08",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "084926-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Albans, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; 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.