Provider Demographics
NPI:1346823150
Name:SHAFFER, JORDAN (LMSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:PYLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21132-1023
Mailing Address - Country:US
Mailing Address - Phone:443-567-0245
Mailing Address - Fax:
Practice Address - Street 1:4 NORTH AVE BLDG C
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2314
Practice Address - Country:US
Practice Address - Phone:410-449-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25425104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker