Provider Demographics
NPI:1528419454
Name:SHEARMAN, KAITLIN (LMSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:SHEARMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 W 146TH ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3744
Mailing Address - Country:US
Mailing Address - Phone:484-788-3224
Mailing Address - Fax:
Practice Address - Street 1:265 W 146TH ST APT 12A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3744
Practice Address - Country:US
Practice Address - Phone:484-788-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker