MEDICARE: CASSANDRA SHAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW82381	CA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053526897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA SHAW

Provider Business Mailing Address
First Line	:	299 12TH ST
Second Line	:
City	:	MARINA
State	:	CA
Zip	:	93933-6003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 BAUMANN RD
Second Line	:
City	:	CASTROVILLE
State	:	CA
Zip	:	95012-9745
Country	:	US
Telephone Number	:	831-632-2414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	10/04/2018

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Directions to “ CASSANDRA SHAW ” Practice Location

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