Active NPI
Kristen Shaw
- Counselor
- Bangor, ME
National Provider Identifier
1982468161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- XL7380
- Practice address
- 34 Penn PLZ
Bangor, ME 04401-3620 - Phone
- (207) 941-2952
- Fax
- (207) 941-2955
- NPI assigned
- Feb 8, 2024
- Last updated
- Feb 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | XL7380 | ME | Primary |
Addresses
Primary practice location
34 Penn PLZ
Bangor, ME 04401-3620
Mailing address
60 Mount Desert Dr
Bangor, ME 04401-2326
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| XL7380 | ME | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707350400000",
"number": "1982468161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 MOUNT DESERT DR",
"city": "BANGOR",
"state": "ME",
"postal_code": "044012326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 PENN PLZ",
"city": "BANGOR",
"state": "ME",
"postal_code": "044013620",
"telephone_number": "207-941-2952",
"fax_number": "207-941-2955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "KRISTEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-08",
"last_updated": "2024-02-08",
"certification_date": "2024-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "ME",
"license": "XL7380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.