Provider Demographics
NPI:1245626191
Name:SHAW, DANA V (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:V
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 YORK RD
Mailing Address - Street 2:#B12
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4225
Mailing Address - Country:US
Mailing Address - Phone:410-532-2476
Mailing Address - Fax:410-532-2747
Practice Address - Street 1:5209 YORK RD
Practice Address - Street 2:#B12
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4225
Practice Address - Country:US
Practice Address - Phone:410-532-2476
Practice Address - Fax:410-532-2747
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical