MEDICARE: DR. CRISTINA LEE SHAW PHD, MSW

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	2363-C	AR

General Provider Information

NPI Number	:	1912129545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTINA LEE SHAW PHD, MSW

Provider Business Mailing Address
First Line	:	PO BOX 536
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80502-0536
Country	:	US
Telephone Number	:	303-775-7221
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 BROADWAY ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3154
Country	:	US
Telephone Number	:	303-775-7221
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	12/28/2017

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