Provider Demographics
NPI:1447662424
Name:SHAW, LIANNA (LMFT)
Entity type:Individual
Prefix:
First Name:LIANNA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1527
Mailing Address - Country:US
Mailing Address - Phone:609-464-3394
Mailing Address - Fax:
Practice Address - Street 1:607 N JEROME AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-1527
Practice Address - Country:US
Practice Address - Phone:609-464-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81286106H00000X
NJ37FI00193100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist