MEDICARE: SHAWN D HACKETT LCSW

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	C016706	NC
2	1041C0700X	Clinical Social Worker	22858	CA
3	1041C0700X	Clinical Social Worker	0904015690	VA

General Provider Information

NPI Number	:	1285786582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN D HACKETT LCSW

Provider Business Mailing Address
First Line	:	5060 SHOREHAM PL STE 300
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5976
Country	:	US
Telephone Number	:	877-840-6956
Fax Number	:	619-840-6956

Provider Business Practice Location Address
First Line	:	301 GREEN STREET
Second Line	:	SUITE 14
City	:	GREENSBORO
State	:	NC
Zip	:	27401
Country	:	US
Telephone Number	:	888-382-7190
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	02/19/2026

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Directions to “ SHAWN D HACKETT LCSW” Practice Location

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