MEDICARE: MELISSA SHAW MSW, 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	1774	CO

General Provider Information

NPI Number	:	1336405273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SHAW MSW, LCSW

Provider Business Mailing Address
First Line	:	13905 W LAYTON CIR
Second Line	:
City	:	MORRISON
State	:	CO
Zip	:	80465-1070
Country	:	US
Telephone Number	:	314-941-0676
Fax Number	:

Provider Business Practice Location Address
First Line	:	12211 W ALAMEDA PKWY STE 201
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2825
Country	:	US
Telephone Number	:	720-583-5668
Fax Number	:

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	10/08/2021

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