Provider Demographics
NPI:1013465517
Name:SHAFFER, ANDREW (BSL)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COURTLAND RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-6609
Mailing Address - Country:US
Mailing Address - Phone:717-657-2080
Mailing Address - Fax:717-657-2290
Practice Address - Street 1:5351C JAYCEE AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2997
Practice Address - Country:US
Practice Address - Phone:717-657-2080
Practice Address - Fax:717-657-2290
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health