Provider Demographics
NPI:1336864107
Name:SHAW, CAROLE JEAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:JEAN
Last Name:SHAW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 208TH ST SW # 5963
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5800
Mailing Address - Country:US
Mailing Address - Phone:425-478-8111
Mailing Address - Fax:
Practice Address - Street 1:20702 82ND AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6723
Practice Address - Country:US
Practice Address - Phone:425-478-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601994951041C0700X
WA1041C0700X
1041C0700X
WALW601994951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical