Basic Information
| Provider Information | |||||||||
| NPI: | 1457882045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAW | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 WARBURTON AVE | ||||||||
| Address2: | C/O WJCS DSS SATELLITE OFFICE | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107012721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142312590 | ||||||||
| FaxNumber: | 9142312125 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 WARBURTON AVE | ||||||||
| Address2: | C/O WJCS DSS SATELLITE OFFICE | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107012721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142312590 | ||||||||
| FaxNumber: | 9142312125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2017 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 092935 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.