Provider Demographics
NPI:1417459835
Name:SHAW, KATHLEEN GEM (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:GEM
Last Name:SHAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 ARNET ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-1601
Mailing Address - Country:US
Mailing Address - Phone:571-244-9875
Mailing Address - Fax:
Practice Address - Street 1:5805 ARNET ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-1601
Practice Address - Country:US
Practice Address - Phone:571-244-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008398103G00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist