Basic Information
| Provider Information | |||||||||
| NPI: | 1780045153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAW | ||||||||
| FirstName: | MARSHAE | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | PLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 ROBERTS DRIVE | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71655 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 ROBERTS DRIVE | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703679732 | ||||||||
| FaxNumber: | 8704606133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2016 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.