1598133886 NPI number — MS. ORA MAE SHAW LIC. CLINICAL SOCIAL

Table of content: MS. ORA MAE SHAW LIC. CLINICAL SOCIAL (NPI 1598133886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598133886 NPI number — MS. ORA MAE SHAW LIC. CLINICAL SOCIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
ORA
Provider Middle Name:
MAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LIC. CLINICAL SOCIAL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598133886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70153-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-615-5862
Provider Business Mailing Address Fax Number:
504-821-7596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 WALMSLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70125-3650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-615-5862
Provider Business Practice Location Address Fax Number:
504-821-7596
Provider Enumeration Date:
09/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2875 . This is a "LCSW" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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