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DAESEONG SHIN LCPC
NPI 1073322558
Counselor in Glen Burnie, MD

Active since December 30, 2024PECOS Enrolled
429 INGRAM CT, GLEN BURNIE, MD 21061(443) 585-8167 Get Directions Write a Review

NPPES record last updated: January 2, 2025. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Daeseong Shin Lcpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DAESEONG SHIN LCPC (NPI 1073322558) is an individual counselor in Glen Burnie, Maryland, licensed in Maryland (LC14961) and active in the NPI registry since December 2024. He is enrolled in Medicare PECOS and maintains a secondary practice location in Owings Mills.

NPPES Registry Identity

NPI1073322558
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameDAESEONG SHINCredential: LCPC
Location Address429 INGRAM CTGlen Burnie, MD 21061-6125
Mailing Address429 Ingram CtGlen Burnie, MD 21061-6125 · (443) 585-8167
Phone(443) 585-8167
Sole ProprietorNo
Enumeration DateDecember 30, 2024
Last NPPES UpdateJanuary 2, 2025
NPPES CertifiedJanuary 2, 2025
✔ NPI 1073322558 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
License✔ Licensed in MD · LC14961
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
429 INGRAM CT, Glen Burnie, MD 21061
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Secondary Practice Location 1

Location 19419 Common Brook Rd Ste 208Owings Mills, MD 21117-7570 · Phone (443) 585-8167 ext. 742

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Daeseong Shin Lcpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Daeseong Shin's NPI number?

The NPI number for Daeseong Shin is 1073322558. It was assigned to this individual provider in the NPPES registry on December 30, 2024.

Where is Daeseong Shin located?

Daeseong Shin practices at 429 Ingram Ct, Glen Burnie, MD 21061. The listed phone number is (443) 585-8167.

What is Daeseong Shin's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Is Daeseong Shin enrolled in Medicare?

Yes. Daeseong Shin is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Daeseong Shin was last updated on January 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.