Kathleen R Shea, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12400 Issued in TX

Practice address

1516 Cooper St
Fort Worth, TX 76104-2710

Phone

(682) 885-1480

Fax

(682) 885-3600

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: kshea16964@cookchildrens.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cook Children'S Medical Center

  • Clinical Child & Adolescent Psychologist
  • Fort Worth, TX
  • NPI 1942509963
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1184701716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99213",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990213",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 COOPER ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042710",
            "telephone_number": "682-885-1480",
            "fax_number": "682-885-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "KATHLEEN",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "12400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kshea16964@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "1516 Cooper St",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761042710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kymm Shaw, COTA
• Martin K Shaw, LPC, LMFT
• Sarah Cornelia Shaw, DO
• Shuntoyia Yshay Shaw, PBT
• William J Shaw IV, PA-C
• Michael P Shea, O.D.
• Hallie Sheade, PHD, LPC-S, RPT-S
• Kimberly A Sheafer
• Christine Shearer
• Kimberly Jean Shearer, RNFA. CNOR

• Clinical Social Worker in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.