Provider Demographics
NPI:1275359358
Name:PAIGE, SHAWN (LPMFT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:PAIGE
Suffix:
Gender:M
Credentials:LPMFT
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:ANTHONY
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPMFT
Mailing Address - Street 1:22822 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2907
Mailing Address - Country:US
Mailing Address - Phone:929-410-7704
Mailing Address - Fax:
Practice Address - Street 1:444 S SALINA ST UNIT 186
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13201-2108
Practice Address - Country:US
Practice Address - Phone:929-269-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06-P132800-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist