Provider Demographics
NPI:1659849966
Name:SHAW, PRINCESS NATASHA (LMSW)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:NATASHA
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 BOYNTON AVE APT 3H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4619
Mailing Address - Country:US
Mailing Address - Phone:646-943-0563
Mailing Address - Fax:
Practice Address - Street 1:880 BOYNTON AVE APT 3H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4619
Practice Address - Country:US
Practice Address - Phone:646-943-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100505-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker