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NPI Code Detail

MEDICARE: KATHLEEN R SHEA LCSW

MEDICARE: KATHLEEN R SHEA 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
11041C0700XClinical Social Worker12400TX

General Provider Information

NPI Number : 1184701716
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN R SHEA LCSW
Provider Business Mailing Address
First Line : PO BOX 99213
Second Line :
City : FORT WORTH
State : TX
Zip : 76199-0213
Country : US
Telephone Number : 682-885-1855
Fax Number : 682-885-7347
Provider Business Practice Location Address
First Line : 1516 COOPER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2710
Country : US
Telephone Number : 682-885-1480
Fax Number : 682-885-3600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 04/09/2021

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Directions to “ KATHLEEN R SHEA LCSW” Practice Location

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