MEDICARE: HILARY GORDON SHAW LCSW06

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	14523	TX

General Provider Information

NPI Number	:	1447304662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILARY GORDON SHAW LCSW06

Provider Business Mailing Address
First Line	:	5210 MORNINGSIDE AVE.
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206
Country	:	US
Telephone Number	:	214-515-9165
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 MORNINGSIDE AVE.
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206
Country	:	US
Telephone Number	:	214-515-9165
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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