Provider Demographics
NPI:1265923353
Name:SCHAEFFER, BENJAMIN ADAM (RAS I, CCMI)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ADAM
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:RAS I, CCMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 POTRERO AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1430
Mailing Address - Country:US
Mailing Address - Phone:415-487-6733
Mailing Address - Fax:415-487-6724
Practice Address - Street 1:440 POTRERO AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1430
Practice Address - Country:US
Practice Address - Phone:415-487-6733
Practice Address - Fax:415-487-6724
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8537-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)