Provider Demographics
NPI:1346137825
Name:SHAW FOUNDATION CORPORATION
Entity type:Organization
Organization Name:SHAW FOUNDATION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCPC;LCADC
Authorized Official - Phone:443-629-5515
Mailing Address - Street 1:2814 W GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5335
Mailing Address - Country:US
Mailing Address - Phone:443-629-5515
Mailing Address - Fax:
Practice Address - Street 1:2814 W GARRISON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5335
Practice Address - Country:US
Practice Address - Phone:443-629-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty