MEDICARE: CATHERINE SHANE

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15972	NC
2	101YM0800X	Mental Health Counselor	10103	NC
3	101YM0800X	Mental Health Counselor	012538	NY

General Provider Information

NPI Number	:	1922404573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE SHANE

Provider Business Mailing Address
First Line	:	103 RACHEL CARSON WAY
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14850-9395
Country	:	US
Telephone Number	:	828-252-7775
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 RACHEL CARSON WAY
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14850-9395
Country	:	US
Telephone Number	:	828-252-7775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	01/17/2023

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Directions to “ CATHERINE SHANE ” Practice Location

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