Provider Demographics
NPI:1528003571
Name:SHAW, NORMA KEIL (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:KEIL
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:MARIE
Other - Last Name:BANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW,LMSW
Mailing Address - Street 1:2314 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3045
Mailing Address - Country:US
Mailing Address - Phone:313-562-6633
Mailing Address - Fax:313-562-0880
Practice Address - Street 1:2314 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3045
Practice Address - Country:US
Practice Address - Phone:313-562-6633
Practice Address - Fax:313-562-0880
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010143011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M09180025Medicare ID - Type Unspecified
MIS84307Medicare UPIN