Provider Demographics
NPI:1083990097
Name:UPSHAW, CATHERINE V (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:V
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 HORIZON LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6393
Mailing Address - Country:US
Mailing Address - Phone:315-836-5089
Mailing Address - Fax:
Practice Address - Street 1:9390 FORD AVE STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6418
Practice Address - Country:US
Practice Address - Phone:315-836-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085086104100000X
NY0830761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker