Provider Demographics
NPI:1922704063
Name:SHAFER, BENJAMIN (RBT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SHAFER
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11983 TAMIAMI TRL N # 121
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1603
Mailing Address - Country:US
Mailing Address - Phone:800-975-1871
Mailing Address - Fax:800-875-1871
Practice Address - Street 1:7594 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5188
Practice Address - Country:US
Practice Address - Phone:800-875-1871
Practice Address - Fax:800-875-1871
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23254965106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician