Provider Demographics
NPI:1972542439
Name:SCHAFER, CHANNAH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CHANNAH
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2061
Mailing Address - Country:US
Mailing Address - Phone:781-784-9728
Mailing Address - Fax:781-784-6696
Practice Address - Street 1:30 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2061
Practice Address - Country:US
Practice Address - Phone:781-784-9728
Practice Address - Fax:781-784-6696
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23584Medicare ID - Type Unspecified