Provider Demographics
NPI:1235214024
Name:SHAFFAR, JAMES RUSSELL (MSW, LISW, CSAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RUSSELL
Last Name:SHAFFAR
Suffix:
Gender:M
Credentials:MSW, LISW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG VICENZA
Mailing Address - Street 2:CMR 427 BOX 1548
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USAG VICENZA
Practice Address - Street 2:CMR 427 BOX 1548
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09630
Practice Address - Country:US
Practice Address - Phone:01139044-471-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1183-03R101YA0400X
IL180-004212101YP2500X
OHI06000611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional