Basic Information
| Provider Information | |||||||||
| NPI: | 1700218831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARTHY-SHAW | ||||||||
| FirstName: | ERIN | ||||||||
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| Credential: | MSN, APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 TRIEBLE AVENUE | ||||||||
| Address2: | STE 5 PMB 420 | ||||||||
| City: | BALLSTON SPA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12020 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2233 STATE ROUTE 86 | ||||||||
| Address2: | |||||||||
| City: | SARANAC LAKE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129835644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188972850 | ||||||||
| FaxNumber: | 5188972605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 402324 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 04959899 | 05 | NY | MEDICAID |