Individual provider Active NPI

Kimberly Shaw, MSW, LICSW

  • Clinical Social Worker
  • Bedford, NH
National Provider Identifier
1992157879
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2227 Issued in NH
Practice address
18 Constitution Dr Ste 5
Bedford, NH 03110-6076
Phone
(603) 472-5279
Fax
(603) 488-1682
NPI assigned
Jul 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

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 2227 NH Primary

Addresses

Primary practice location

18 Constitution Dr Ste 5
Bedford, NH 03110-6076

Mailing address

18 Constitution Dr Ste 5
Bedford, NH 03110-6076
Phone (603) 472-5279

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20190705001078 NH Practitioner - Clinical Social Worker 1456686906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Enso Counseling Group PLLCGroup PAC ID 1759795321, 4 clinicians

Practice addresses (Care Compare)

1 Barberry LN
Concord, NH 03301-2417
Phone (617) 819-0914

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2227NHMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Enso Counseling Group, PLLC CurrentSince Aug 1, 2022 Accepting new patients

Locations

1 Barberry Ln
Concord, NH 03301
Phone (617) 207-6684

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1992157879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 CONSTITUTION DR STE 5",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106076",
            "telephone_number": "603-472-5279",
            "fax_number": "603-488-1682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 CONSTITUTION DR STE 5",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106076",
            "telephone_number": "603-472-5279",
            "fax_number": "603-488-1682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KIMBERLY",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-05",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "2227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, NH

Sources for this page

Verify at the official NPI Registry.