Provider Demographics
NPI:1831307974
Name:SHATOFF, DEBRA KATHERINE (EDD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:KATHERINE
Last Name:SHATOFF
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WEST PORT PLAZA DR
Mailing Address - Street 2:#360
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-576-5503
Mailing Address - Fax:314-725-6350
Practice Address - Street 1:77 WEST PORT PLAZA DR
Practice Address - Street 2:SUITE 360
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146
Practice Address - Country:US
Practice Address - Phone:314-576-5503
Practice Address - Fax:314-725-6350
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00966103T00000X, 103TP2701X
MO300072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist