Provider Demographics
NPI:1750519872
Name:SHAW, MARNI R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARNI
Middle Name:R
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MALKA
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:334 PENNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3406
Mailing Address - Country:US
Mailing Address - Phone:973-271-7788
Mailing Address - Fax:
Practice Address - Street 1:203 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4717
Practice Address - Country:US
Practice Address - Phone:973-271-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053428001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical