Provider Demographics
NPI:1184634172
Name:SHAW, PAUL DUANE (MSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DUANE
Last Name:SHAW
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BEERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1930
Mailing Address - Country:US
Mailing Address - Phone:781-659-1673
Mailing Address - Fax:781-659-1673
Practice Address - Street 1:17 BEERS AVE
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1930
Practice Address - Country:US
Practice Address - Phone:781-659-1673
Practice Address - Fax:781-659-1673
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1008371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01040Medicare ID - Type Unspecified
MAP01040Medicare UPIN