Provider Demographics
NPI:1366987588
Name:SHAW, WILLIAM BARNABY
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BARNABY
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 POPLAR ST
Mailing Address - Street 2:APT 15
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2506
Mailing Address - Country:US
Mailing Address - Phone:413-464-4901
Mailing Address - Fax:
Practice Address - Street 1:79 POPLAR ST
Practice Address - Street 2:APT 15
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2506
Practice Address - Country:US
Practice Address - Phone:413-464-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-24
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician