Provider Demographics
NPI:1427192103
Name:SHAW, REBECCA LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:888 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044
Mailing Address - Country:US
Mailing Address - Phone:917-903-0160
Mailing Address - Fax:
Practice Address - Street 1:80 VAN DAM ST 2ND FL
Practice Address - Street 2:FEGS MANHATTAN MH CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-366-8040
Practice Address - Fax:212-366-8144
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07177811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical