Provider Demographics
NPI:1710017850
Name:SHAW, EMILY (LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:HOUSATONIC
Mailing Address - State:MA
Mailing Address - Zip Code:01236-0264
Mailing Address - Country:US
Mailing Address - Phone:413-854-1349
Mailing Address - Fax:
Practice Address - Street 1:151 FRONT STREET
Practice Address - Street 2:
Practice Address - City:HOUSATONIC
Practice Address - State:MA
Practice Address - Zip Code:01236
Practice Address - Country:US
Practice Address - Phone:413-854-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical