Provider Demographics
NPI:1215072103
Name:SHAW, LAURA Z (LICSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:Z
Last Name:SHAW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2004
Mailing Address - Country:US
Mailing Address - Phone:617-964-3813
Mailing Address - Fax:617-795-0313
Practice Address - Street 1:116 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2004
Practice Address - Country:US
Practice Address - Phone:617-964-3813
Practice Address - Fax:617-795-0313
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10245831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1024583OtherSOCIAL WORK LICENSE