Provider Demographics
NPI:1780696005
Name:SHAW, DONALD ANDREW (LCSW)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ANDREW
Last Name:SHAW
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 SW KOLL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6026
Mailing Address - Country:US
Mailing Address - Phone:503-290-6477
Mailing Address - Fax:
Practice Address - Street 1:15100 SW KOLL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6026
Practice Address - Country:US
Practice Address - Phone:503-290-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL40861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD357602OtherMHN
MD7734703OtherAETNA
MD407367300Medicaid
DCA2840146OtherBCBS OF DC
MD64529901OtherBCBS OF MD
MD796986000OtherMAGELLAN
MD254442OtherKAISER
MD407367300Medicaid