Provider Demographics
NPI:1386632446
Name:SHAFFER, RUTH M (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:M
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:6746 161ST ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3111
Mailing Address - Country:US
Mailing Address - Phone:917-295-6099
Mailing Address - Fax:718-904-7006
Practice Address - Street 1:1150 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4603
Practice Address - Country:US
Practice Address - Phone:718-904-7036
Practice Address - Fax:718-904-7024
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2016-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010971-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01376425Medicaid
NY01376425Medicaid