Provider Demographics
NPI:1427040716
Name:SHAW, LAUREL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MATHER RD
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-4115
Mailing Address - Country:US
Mailing Address - Phone:607-433-4726
Mailing Address - Fax:607-432-3352
Practice Address - Street 1:164 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3503
Practice Address - Country:US
Practice Address - Phone:607-432-3352
Practice Address - Fax:607-432-3352
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035523-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB3666Medicare ID - Type Unspecified