Healthcare Provider Details

I. General information

NPI: 1316273600
Provider Name (Legal Business Name): TINA MAY SHAFER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WEBSTER AVE
ROCHESTER NY
14609-4732
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-482-9290
  • Fax: 585-324-5812
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004665
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: