Provider Demographics
NPI:1750333654
Name:KATSH, SHELLEY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
Last Name:KATSH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MARBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6171
Mailing Address - Country:US
Mailing Address - Phone:401-725-7806
Mailing Address - Fax:
Practice Address - Street 1:229 WATERMAN ST
Practice Address - Street 2:JEWISH FAMILY SERVICE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5212
Practice Address - Country:US
Practice Address - Phone:401-331-1244
Practice Address - Fax:401-331-5772
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISK57821Medicaid