Provider Demographics
NPI:1518075910
Name:SHAW, MERRI LEA (MSW)
Entity Type:Individual
Prefix:
First Name:MERRI
Middle Name:LEA
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 1:22 MILL ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4784
Mailing Address - Country:US
Mailing Address - Phone:781-646-9101
Mailing Address - Fax:
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 405
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-646-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1008361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02440OtherBLUE CROSS BLUE SHIELD
MA094907OtherMANAGED HEALTH NETWORK
MAP00086621OtherPALMETTO GBA RR MEDICARE
MAP00086621OtherPALMETTO GBA RR MEDICARE