Provider Demographics
NPI:1669682225
Name:SHAW, LIAM WARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LIAM
Middle Name:WARD
Last Name:SHAW
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 DRESDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2615
Mailing Address - Country:US
Mailing Address - Phone:207-215-6791
Mailing Address - Fax:207-395-2560
Practice Address - Street 1:U.S. ROUTE 202
Practice Address - Street 2:2518 SUITE 1A
Practice Address - City:EAST WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04343
Practice Address - Country:US
Practice Address - Phone:207-395-2555
Practice Address - Fax:207-395-2560
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC60391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical