Individual
NANCY E SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
91 AUBURN ST STE J1008, PORTLAND, ME 04103-6008
(207) 761-2796
Mailing address
91 AUBURN STREET SUITE J #1008, PORTLAND, ME 04103
(207) 761-2796
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CC2192
ME
101YP2500X
Professional Counselor
Primary
CC2192
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24Z060047ME01
ANTHEM BC&BS
ME
01
—
545213000
MAGELLAN/AETNA
ME
Enumeration date
06/27/2005
Last updated
12/15/2023
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