Shannon Marie Klock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

58.012170 Issued in CT

Practice address

27 Hartford Tpke Ste 207
Vernon, CT 06066-5245

Phone

(860) 416-2515

NPI assigned

Apr 27, 2022

Sex

Female

Sole proprietor

Yes

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

Enrolled in CT

Eligible to order & refer

• Part B services: No
• 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.

• Harvest Healthcare LLC

  • Clinical Social Worker
  • Avon, CT
  • NPI 1477712917
  Medicare reassignment NPD
• State of Connecticut

  • Adult Mental Health Clinic/Center
  • Norwich, CT
  • NPI 1902831548
  Medicare reassignment NPD
• State of Connecticut

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1992449649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 COLLIE BROOK RD",
            "city": "EAST HAMPTON",
            "state": "CT",
            "postal_code": "064241641",
            "telephone_number": "860-416-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 HARTFORD TPKE STE 207",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060665245",
            "telephone_number": "860-416-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOCK",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "58.012170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kausar Khan, APRN
• Yasmine S Khan, MD
• Robert A Kiel, DMD
• Brian King, PHARMD
• Hortense E Kingue
• Russell T Kloter, LADC
• Amber Koelsch
• Dennis Kofi Konadu, LCSW, LADC
• Paul D Korus, D.M.D
• Gary Kovachi, LMFT

• Clinical Social Worker in Vernon, CT
• Providers in Vernon, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.