Healthcare Provider Details

I. General information

NPI: 1194976308
Provider Name (Legal Business Name): KATHRYN C SHAFER PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W INDIANTOWN RD STE 100
JUPITER FL
33458-7555
US

IV. Provider business mailing address

675 W INDIANTOWN RD STE 100
JUPITER FL
33458-7555
US

V. Phone/Fax

Practice location:
  • Phone: 561-799-6789
  • Fax: 561-575-7545
Mailing address:
  • Phone: 561-799-6789
  • Fax: 561-575-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2276
License Number StateFL

VIII. Authorized Official

Name: KATHRYN C SHAFER
Title or Position: OWNER
Credential: PHD
Phone: 561-799-6789