Provider Demographics
NPI:1568243426
Name:SHIVERS, KATE RENEE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:RENEE
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LAPIDUM RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-1710
Mailing Address - Country:US
Mailing Address - Phone:267-455-1420
Mailing Address - Fax:
Practice Address - Street 1:1002 LAPIDUM RD
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-1710
Practice Address - Country:US
Practice Address - Phone:508-202-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD226941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical