Provider Demographics
NPI:1881716637
Name:SHAW, DEBORAH RUTH (MSW PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:RUTH
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BOULEVARD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-826-7067
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BOULEVARD
Practice Address - Street 2:SUITE 900
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-826-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 128501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical