Provider Demographics
NPI:1861769168
Name:SHAW, LAURA (MS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 BRICKYARD ROAD
Mailing Address - Street 2:
Mailing Address - City:WARNERS
Mailing Address - State:NY
Mailing Address - Zip Code:13164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2860 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:WARNERS
Practice Address - State:NY
Practice Address - Zip Code:13164-9724
Practice Address - Country:US
Practice Address - Phone:516-581-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health