Provider Demographics
NPI:1174635619
Name:SHEARER, SUSAN KATHLEEN (CPAT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:SHEARER
Suffix:
Gender:F
Credentials:CPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73070
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:502-241-2909
Mailing Address - Fax:502-241-6811
Practice Address - Street 1:6200 CRESTWOOD STA
Practice Address - Street 2:STE A
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7418
Practice Address - Country:US
Practice Address - Phone:502-241-2909
Practice Address - Fax:502-241-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0125OtherBOARD LICENSE ART THERAPY