Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shelley Beth Kingsbury, LCSW

Individual provider Clinical Social Worker · NPI 1104462654

Shelley Beth Kingsbury, LCSW is a Clinical Social Worker in Mystic, Connecticut. Graduated from Fordham University School of Medicine in 2016, 10 years ago. Practices with State of Connecticut, a 267-clinician group and accepts Medicare assignment. Licensed in Connecticut.

Years since qualifying
10
Trained at
Fordham University School of Medicine
Licensed in
CT
In the registry since
2019
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

1101 Noank Ledyard Rd # 12
Mystic, CT 06355-1361
Phone: (860) 861-8393
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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 010666 (CT)

Record details

NPI number1104462654
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorYes
NPI enumeratedNovember 20, 2019
Last updated in NPPESAugust 26, 2021
Certification dateAugust 26, 2021

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolFORDHAM UNIVERSITY SCHOOL OF MEDICINE
Graduated 2016 (10 years in practice)
Group practice State Of Connecticut — 267 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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