Provider Demographics
NPI:1134970817
Name:SHEA, CATHLEEN ELIZABETH (LMHC)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:ELIZABETH
Last Name:SHEA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 HAWKEYE DR
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9514
Mailing Address - Country:US
Mailing Address - Phone:315-256-5932
Mailing Address - Fax:
Practice Address - Street 1:7266 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2649
Practice Address - Country:US
Practice Address - Phone:315-458-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health