Provider Demographics
NPI:1700218831
Name:MCCARTHY-SHAW, ERIN (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCCARTHY-SHAW
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TRIEBLE AVENUE
Mailing Address - Street 2:STE 5 PMB 420
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 TRIEBLE AVE STE 5
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-6027
Practice Address - Country:US
Practice Address - Phone:203-349-9605
Practice Address - Fax:203-533-0766
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4700163W00000X
NY741263163W00000X
NY402324363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04959899Medicaid