MEDICARE: MR. DANIEL SHAW LCSW

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	1041C0700X	Clinical Social Worker	R054171-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R054171-1	OTHER	NY	LCSW

General Provider Information

NPI Number	:	1154371698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL SHAW LCSW

Provider Business Mailing Address
First Line	:	405 MAPLE AVE
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-1319
Country	:	US
Telephone Number	:	845-548-2561
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 W 56TH ST
Second Line	:	STE. 5K
City	:	NEW YORK
State	:	NY
Zip	:	10019-4312
Country	:	US
Telephone Number	:	212-581-6658
Fax Number	:	212-581-6658

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/19/2014

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Directions to “ MR. DANIEL SHAW LCSW” Practice Location

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