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NPI Code Detail

MEDICARE: MR. ANDREW JAMES SHAW MFT

MEDICARE: MR. ANDREW JAMES SHAW MFT
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
1106H00000XMarriage & Family TherapistMFC47004CA

General Provider Information

NPI Number : 1356472625
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW JAMES SHAW MFT
Provider Business Mailing Address
First Line : 3527 OCEAN VIEW BLVD
Second Line :
City : GLENDALE
State : CA
Zip : 91208-1211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3527 OCEAN VIEW BLVD
Second Line :
City : GLENDALE
State : CA
Zip : 91208-1211
Country : US
Telephone Number : 323-450-6630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 06/28/2010

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