Provider Demographics
NPI:1427073725
Name:SHAW-SMITH, ELLEN MICHELLE (LICSW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:MICHELLE
Last Name:SHAW-SMITH
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 1:140 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2560
Mailing Address - Country:US
Mailing Address - Phone:413-538-5728
Mailing Address - Fax:
Practice Address - Street 1:17 HAWLEY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3374
Practice Address - Country:US
Practice Address - Phone:413-658-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23744Medicare ID - Type Unspecified