Faya Kacos-Shiu, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11502123 Issued in WI

Practice address

4536 22ND Ave
Kenosha, WI 53140-5917

Phone

(262) 656-0044

Fax

(262) 649-1977

NPI assigned

Mar 5, 2015

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Kenosha Community Health Center, Inc.Group PAC ID 0941195168, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kenosha Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Kenosha, WI
  • NPI 1265435960

  Mental Health

  Medicare reassignment Care Compare group NPD
• Counseling Center of Grayslake LTD.

  • Clinical Social Worker
  • Grayslake, IL
  • NPI 1194267385
  Medicare reassignment NPD
• Ganesha Institute of Neurology and Psychiatry SC

  • Neurology Physician
  • Libertyville, IL
  • NPI 1629478599

  Clinical

  Medicare reassignment NPD
• Ganesha Institute of Neurology and Psychiatry SC

  • Neurology Physician
  • Kenosha, WI
  • NPI 1619731320

  Clinical

  NPD
• Kenosha Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Kenosha, WI
  • NPI 1770789489
  NPD
• Kenosha Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Racine, WI
  • NPI 1215823406
  NPD
• Kenosha Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Silver Lake, WI
  • NPI 1568931541
  NPD (past)
• Kenosha Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Kenosha, WI
  • NPI 1710635677
  NPD (past)

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

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1194118802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4006 WASHINGTON RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531444819",
            "telephone_number": "262-656-0044",
            "fax_number": "262-649-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4536 22ND AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405917",
            "telephone_number": "262-656-0044",
            "fax_number": "262-649-1977"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4006 Washington Rd",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531444819",
            "country_code": "US",
            "telephone_number": "262-656-0044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "903 S 2nd St",
            "address_purpose": "LOCATION",
            "city": "Silver Lake",
            "state": "WI",
            "postal_code": "531701747",
            "country_code": "US",
            "telephone_number": "262-656-0044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6226 14th Ave",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531434413",
            "country_code": "US",
            "telephone_number": "262-656-0044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "930 Dr Martin Luther King Dr",
            "address_purpose": "LOCATION",
            "city": "Racine",
            "state": "WI",
            "postal_code": "534043008",
            "country_code": "US",
            "telephone_number": "262-656-0044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KACOS-SHIU",
        "first_name": "FAYA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-05",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "11502123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366006600",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100321033",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edmund Jung
• Junith M. Thompson, M.D., S.C.
• Rosalinda Jurvis, CNA
• Just Like Familt LLC
• Pollyanna Kabara, PA-C
• Dianna Kaczmarek, OTR
• Katherine Leigh Kaczmarek, LCP-IT
• Pamela A Kaczmarek, PSYD
• Saba J Kadlec, MD
• Cynthia Kadziulis, RN

• Clinical Social Worker in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.