Provider Demographics
NPI:1013312388
Name:SHAFFER, LISA MAE (LPCMH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MAE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 SHELL RD
Mailing Address - Street 2:
Mailing Address - City:CARNEY'S POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08069
Mailing Address - Country:US
Mailing Address - Phone:302-415-9215
Mailing Address - Fax:
Practice Address - Street 1:500 W 10TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:866-477-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health