Roberta E Shaw, L.C.P.C.
Individual provider Active NPI Professional Counselor · Fairfield, ME
NPI 1386797280 · NPPES record last updated Apr 23, 2018
Key facts
- NPI
- 1386797280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- CC987 (ME)
- Practice address
- 12 Damascus Rd
Fairfield, ME 04937-4307 - Phone
- (207) 453-7980
- Fax
- (207) 649-8384
- NPI assigned
- Jan 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC987 | ME | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC987 | ME | Yes |
Addresses
Primary practice location
12 Damascus Rd
Fairfield, ME 04937-4307
Mailing address
12 Damascus Rd
Fairfield, ME 04937-4307
Phone (207) 453-7980
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128320000 | Medicaid | ME |
Other providers in Fairfield, ME
- Sara P Roberts
- Madison Nancy Root
- Shane G Savage
- Karren S Seely
- Angie M. Shahmoradi
- Clayton Smith
- Luc Snipe
- Carrie Stackpole
- Christine Marie Stevens-Sheehan
- Stacey N Stevens
All providers in Fairfield, ME · Professional Counselor in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.