Individual
SUSAN SHAW I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
50 LYDIA LN, SOUTH PORTLAND, ME 04106-2156
(207) 331-6102
Mailing address
50 LYDIA LN, SOUTH PORTLAND, ME 04106-2156
(207) 331-6102
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC4414
ME
Other
Enumeration date
11/20/2015
Last updated
11/20/2015
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