Provider Demographics
NPI:1255408902
Name:SHAW-ZIRT, BARBARA MERYL (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:MERYL
Last Name:SHAW-ZIRT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SAINT JOHN ST
Mailing Address - Street 2:PO BOX 1311
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-2137
Mailing Address - Country:US
Mailing Address - Phone:845-794-1868
Mailing Address - Fax:845-794-5961
Practice Address - Street 1:10 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2137
Practice Address - Country:US
Practice Address - Phone:845-794-1868
Practice Address - Fax:845-794-5961
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014688103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY211452OtherUNITED BEHAVIORAL HEALTH
NY503089OtherVALUE OPTIONS
NY02145182Medicaid
NY603442OtherMVP HEALTHCARE
NY1035160OtherHUDSON HEALTH PLAN
NYIP559283OtherMAGELLAN BEHAVIORAL HEALT