Provider Demographics
NPI:1184810202
Name:SHAW, JUDITH MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARY
Last Name:SHAW
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 4TH ST.
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091
Mailing Address - Country:US
Mailing Address - Phone:847-525-1420
Mailing Address - Fax:
Practice Address - Street 1:607 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1905
Practice Address - Country:US
Practice Address - Phone:847-525-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0064361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical