Andrea B. Shaw, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ANDREA B. SHAW, LCSW

Practice address

552 Edwardsville Road
Troy, IL 62294

Phone

(618) 520-6963

Fax

(618) 667-7609

NPI assigned

Nov 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Andrea Beth Shaw, LCSWNPI 1851463004

Title

Sole Proprietor

Phone

(618) 520-6963

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, IL2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea Shaw, LCSW

  • Clinical Social Worker
  • Troy, IL
  • NPI 1851463004

  FL

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1083786248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 416",
            "city": "TROY",
            "state": "IL",
            "postal_code": "62294",
            "telephone_number": "618-520-6963",
            "fax_number": "618-667-7609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "552 EDWARDSVILLE ROAD",
            "city": "TROY",
            "state": "IL",
            "postal_code": "62294",
            "telephone_number": "618-520-6963",
            "fax_number": "618-667-7609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREA B. SHAW, LCSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "618-520-6963",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Troy, IL
• Providers in Troy, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.