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General NPI Number Information
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NPI Number | 1386632446
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Entity Type | Individual
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Provider Name | RUTH M SHAFFER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 1150 COMMONWEALTH AVE
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City | BRONX
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State | NY
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Zip | 10472-4603
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Country | US
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Telephone | 718-904-7036
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Fax | 718-904-7024
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Provider Business Mailing Address
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Address Line | 6746 161ST ST APT 3A
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3111
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Country | US
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Telephone | 917-295-6099
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Fax | 718-904-7006
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010971-1
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License Number State | NY
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