Provider Demographics
NPI:1467447615
Name:SHAW, GABRIELLA (MSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1849
Mailing Address - Country:US
Mailing Address - Phone:212-734-4962
Mailing Address - Fax:
Practice Address - Street 1:71 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1849
Practice Address - Country:US
Practice Address - Phone:212-734-4962
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030627-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker