Provider Demographics
NPI:1427186816
Name:SHAW, BARRY (LCMHC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-5346
Mailing Address - Country:US
Mailing Address - Phone:802-387-6077
Mailing Address - Fax:802-387-6077
Practice Address - Street 1:94 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-5346
Practice Address - Country:US
Practice Address - Phone:802-387-6077
Practice Address - Fax:802-387-6077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00029258OtherBLUE CROSS BLUE SHIELD
VT00029258OtherBLUE CROSS BLUE SHIELD