Individual
CHARLES WELLS SHAW V
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
10-42 MITCHELL AVE, BINGHAMTON, NY 13903-1617
(607) 762-2990
Mailing address
33 LEWIS RD, 2ND FL, BINGHAMTON, NY 13905
(607) 729-8156
(607) 729-3982
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
104892
NY
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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