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General NPI Number Information
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NPI Number | 1790103224
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Entity Type | Individual
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Provider Name | AUDREY SHAW M.S.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 16 LINCOLN ST
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City | BRUNSWICK
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State | ME
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Zip | 04011-1900
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Country | US
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Telephone | 603-883-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 123 WORTHING RD
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City | MANCHESTER
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State | ME
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Zip | 04351-3234
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Country | US
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Telephone | 207-530-1995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CC5017
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 000591828
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC5017
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License Number State | ME
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