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General NPI Number Information
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NPI Number | 1184836793
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Entity Type | Individual
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Provider Name | SUSAN D SHAFFER LCMHC
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 1233 SHELBURNE RD STE D4
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7753
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Country | US
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Telephone | 802-582-6750
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 SHELBURNE RD STE D4
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7753
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Country | US
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Telephone | 802-582-6750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0067302
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License Number State | NM
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