Healthcare Provider Details

I. General information

NPI: 1174175772
Provider Name (Legal Business Name): KIMBERLY SCHAFFER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EDGEVIEW DR STE 2B
HACKETTSTOWN NJ
07840-4003
US

IV. Provider business mailing address

1 EDGEVIEW DR STE 2B
HACKETTSTOWN NJ
07840-4003
US

V. Phone/Fax

Practice location:
  • Phone: 908-246-1480
  • Fax:
Mailing address:
  • Phone: 908-246-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ANNE SCHAFFER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 908-246-1480