Healthcare Provider Details

I. General information

NPI: 1679501563
Provider Name (Legal Business Name): MARY SCHAFFER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 KIRKWOOD DR
MENTOR OH
44060-4205
US

IV. Provider business mailing address

PO BOX 570
GRAND RIVER OH
44045-0570
US

V. Phone/Fax

Practice location:
  • Phone: 440-972-0454
  • Fax: 440-972-0459
Mailing address:
  • Phone: 440-477-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.5034
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: