Provider Demographics
NPI:1376890061
Name:SHAY, KATHERINE MELISSA (MSW, LCSW)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MELISSA
Last Name:SHAY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MELISSA
Other - Last Name:BLANKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 N OAKWOOD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4629
Mailing Address - Country:US
Mailing Address - Phone:813-819-8704
Mailing Address - Fax:813-939-5675
Practice Address - Street 1:109 N OAKWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4629
Practice Address - Country:US
Practice Address - Phone:813-819-8704
Practice Address - Fax:813-939-5675
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLSW150811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor