=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487271037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JO SHAW PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2020
-----------------------------------------------------
Last Update Date | 05/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 BISHOP ST STE 2685A
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-3404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-431-9047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 WILLIAMS ST
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18704-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-426-0399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY-1853
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------