Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1073796819 |
---|---|
Provider Name | Dr. Ray Shaw |
First Address | Bronx, NY 10461-1138 |
Second Address | Bronx, NY 10461-1138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2007 |
Last Update Date | 16/12/2007 |