Provider Demographics
NPI:1013113752
Name:SHAW, MELINDA SUE (LSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:SUE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SAINT PETER WAY
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3528
Mailing Address - Country:US
Mailing Address - Phone:724-523-9382
Mailing Address - Fax:
Practice Address - Street 1:114 SAINT PETER WAY
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3528
Practice Address - Country:US
Practice Address - Phone:724-523-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW008980L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA032977Medicare ID - Type Unspecified