Provider Demographics
NPI:1841585213
Name:SHAW, CYNTHIA G (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:G
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 1:6100 219TH ST SW
Mailing Address - Street 2:SUITE 480
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2222
Mailing Address - Country:US
Mailing Address - Phone:206-310-9879
Mailing Address - Fax:425-775-6521
Practice Address - Street 1:6100 219TH ST SW
Practice Address - Street 2:SUITE 480
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2222
Practice Address - Country:US
Practice Address - Phone:206-310-9879
Practice Address - Fax:425-775-6521
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601650781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical