Provider Demographics
NPI:1659804003
Name:ADAM SHAFER, P.C.
Entity Type:Organization
Organization Name:ADAM SHAFER, P.C.
Other - Org Name:MOONLIGHTWELLBEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-537-9951
Mailing Address - Street 1:825 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 W JACKSON BLVD STE 515
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3061
Practice Address - Country:US
Practice Address - Phone:708-537-9951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty