Provider Demographics
NPI:1922327113
Name:SHAW, VICTORIA W (LMSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:W
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 1:55 N BROADWAY
Mailing Address - Street 2:2-23
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1640
Mailing Address - Country:US
Mailing Address - Phone:914-773-7432
Mailing Address - Fax:
Practice Address - Street 1:228 LINDA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2050
Practice Address - Country:US
Practice Address - Phone:914-773-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0802831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical