Organization
SHAWN MUTHERSBAUGH LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN HARRIS MUTHERSBAUGH LCSW (OWNER/SOLO PRIVATE PRACTITIONER)
(518) 390-6890
Entity
Organization
Contact information
Practice address
120 DEFREEST DR STE 175, TROY, NY 12180-7608
(518) 390-6890
(518) 326-0003
Mailing address
120 DEFREEST DR STE 175, TROY, NY 12180-7608
(518) 390-6890
(518) 326-0003
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01645743
—
NY
Enumeration date
09/21/2020
Last updated
09/21/2020
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