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NPI Code Detail

MEDICARE: ANDREA MICHELE SHAW LISW-S

MEDICARE: ANDREA MICHELE SHAW LISW-S
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
11041C0700XClinical Social Worker1800995-SUPVOH
21041C0700XClinical Social Worker34008643AIN

General Provider Information

NPI Number : 1114568169
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA MICHELE SHAW LISW-S
Provider Business Mailing Address
First Line : 412 SWAN CIR
Second Line :
City : ELSMERE
State : KY
Zip : 41018-1940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 909 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1105
Country : US
Telephone Number : 513-977-6829
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2019
Last Update Date : 01/19/2022

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Directions to “ ANDREA MICHELE SHAW LISW-S” Practice Location

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