Provider Demographics
NPI:1891723938
Name:JERRY SHAFER PHD INC.
Entity Type:Organization
Organization Name:JERRY SHAFER PHD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:925-778-1661
Mailing Address - Street 1:3240 LONE TREE WAY
Mailing Address - Street 2:#104
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5559
Mailing Address - Country:US
Mailing Address - Phone:925-778-1661
Mailing Address - Fax:925-778-1661
Practice Address - Street 1:3240 LONE TREE WAY
Practice Address - Street 2:#104
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-5559
Practice Address - Country:US
Practice Address - Phone:925-778-1661
Practice Address - Fax:925-778-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3395103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty