Provider Demographics
NPI:1295733681
Name:SCHAFFER, AMY
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2470
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-2470
Mailing Address - Country:US
Mailing Address - Phone:707-781-7219
Mailing Address - Fax:
Practice Address - Street 1:3558 ROUND BARN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0989
Practice Address - Country:US
Practice Address - Phone:707-571-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14958104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker