Provider Demographics
NPI:1891570040
Name:SHAW, KURTISA L (LMSW)
Entity type:Individual
Prefix:
First Name:KURTISA
Middle Name:L
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ECHO HL
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3600
Mailing Address - Country:US
Mailing Address - Phone:914-693-0600
Mailing Address - Fax:
Practice Address - Street 1:1 ECHO HILL
Practice Address - Street 2:CORDERO BLD RM 114
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522
Practice Address - Country:US
Practice Address - Phone:914-693-0600
Practice Address - Fax:914-517-6837
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089661104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker