Healthcare Provider Details

I. General information

NPI: 1528363561
Provider Name (Legal Business Name): REBECCA SHAFFER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML - 4002
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML - 4002
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-9645
  • Fax: 513-636-3800
Mailing address:
  • Phone: 513-636-9645
  • Fax: 513-636-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042577A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7014
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: