Provider Demographics
NPI:1265015234
Name:SHAFER, JOHN ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:SHAFER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1313
Mailing Address - Country:US
Mailing Address - Phone:317-414-1020
Mailing Address - Fax:
Practice Address - Street 1:644 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1313
Practice Address - Country:US
Practice Address - Phone:317-414-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002377A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical