MEDICARE: MRS. SHANNON MARIE KING LCSWC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 10086	FL
2	1041C0700X	Clinical Social Worker	15689	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Z04FN	OTHER	FL	FLORIDA BLUE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902048176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON MARIE KING LCSWC

Provider Business Mailing Address
First Line	:	6069 SPRUCE POINT CIR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-5508
Country	:	US
Telephone Number	:	240-818-9499
Fax Number	:

Provider Business Practice Location Address
First Line	:	6069 SPRUCE POINT CIR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-5508
Country	:	US
Telephone Number	:	240-818-9499
Fax Number	:	213-283-7741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	01/21/2026

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