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General NPI Number Information
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NPI Number | 1922404573
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Entity Type | Individual
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Provider Name | CATHERINE SHANE
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Gender | Female
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 103 RACHEL CARSON WAY
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City | ITHACA
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State | NY
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Zip | 14850-9395
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Country | US
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Telephone | 828-252-7775
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Fax |
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Provider Business Mailing Address
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Address Line | 103 RACHEL CARSON WAY
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City | ITHACA
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State | NY
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Zip | 14850-9395
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Country | US
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Telephone | 828-252-7775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15972
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10103
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 012538
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License Number State | NY
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