MEDICARE: NANCY E SHAW LCPC

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	101YM0800X	Mental Health Counselor	CC2192	ME
2	101YP2500X	Professional Counselor	CC2192	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	545213000	OTHER	ME	MAGELLAN/AETNA
2	24Z060047ME01	OTHER	ME	ANTHEM BC&BS

General Provider Information

NPI Number	:	1215933031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY E SHAW LCPC

Provider Business Mailing Address
First Line	:	91 AUBURN STREET SUITE J #1008
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103
Country	:	US
Telephone Number	:	207-761-2796
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 AUBURN ST STE J1008
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-6008
Country	:	US
Telephone Number	:	207-761-2796
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	12/15/2023

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Directions to “ NANCY E SHAW LCPC” Practice Location

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