Healthcare Provider Details

I. General information

NPI: 1083578744
Provider Name (Legal Business Name): HARRISON SHAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 GRANGER RD STE 1
BARRE VT
05641-5363
US

IV. Provider business mailing address

59 E STATE ST APT 3
MONTPELIER VT
05602-3078
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-9151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number156.0134279
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: