Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Douglas Mark Shine, LCSW

Individual provider Clinical Social Worker · NPI 1992821201

Mr. Douglas Mark Shine, LCSW is a Clinical Social Worker in Saint Johns, Florida. Qualified in 1972, 54 years ago. Practices with Optum Behavioral Care of North Carolina PC, a 176-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
54
Licensed in
FL
In the registry since
2007
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

1705 Duck Water Ct
Saint Johns, FL 32259-5247
Phone: (904) 287-3122
Fax: (904) 287-3122
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence SW0001447 (FL)

Record details

NPI number1992821201
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedMarch 21, 2007
Last updated in NPPESSeptember 10, 2012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1972 (54 years in practice)
Group practice Optum Behavioral Care Of North Carolina Pc — 176 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Saint Johns