Provider Demographics
NPI:1811458748
Name:SHAW, AMELIA JEAN (MSSW, LCSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:JEAN
Last Name:SHAW
Suffix:
Gender:
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2347
Mailing Address - Country:US
Mailing Address - Phone:937-546-3619
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD MEDICAL CENTER 652/122 SOCIAL WORK
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-2305
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040136711041C0700X
CO0009922206104100000X
104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker