Katherine Melissa Shay, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW15081 Issued in FL

Practice address

109 N Oakwood Ave Ste 105
Brandon, FL 33510-4629

Phone

(813) 819-8704

Fax

(813) 939-5675

NPI assigned

Aug 13, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Katherine Melissa Blanken Former name

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emerald Clover, LLCGroup PAC ID 5496290033, 14 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.

• Emerald Clover, LLC

  dba Ellie Mental Health - St. Petersburg

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • St Petersburg, FL
  • NPI 1972218055
  Medicare reassignment Care Compare group NPD
• Tranquility Wellness Group, LLC

  dba Ellie Mental Health

  • Clinical Social Worker
  • Brandon, FL
  • NPI 1003522723
  Medicare reassignment NPD

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1376890061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N OAKWOOD AVE STE 105",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335104629",
            "telephone_number": "813-819-8704",
            "fax_number": "813-939-5675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N OAKWOOD AVE STE 105",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335104629",
            "telephone_number": "813-819-8704",
            "fax_number": "813-939-5675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAY",
        "first_name": "KATHERINE",
        "middle_name": "MELISSA",
        "name_prefix": "Miss",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW15081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "BLANKEN",
            "middle_name": "MELISSA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David J Shaw, M.S., BCBA
• Heather Shaw, M.S.
• Jessie A Shaw
• Karen Shaw
• Yanaris Shaw, RDN, LDN
• Travis Shearer, PA-C
• Courtney Sheehan
• Sheena Baker PLLC
• Yazen Sheikhah
• Diana Shelton, LMT

• Clinical Social Worker in Brandon, FL
• Providers in Brandon, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.