Provider Demographics
NPI:1336750264
Name:SHAFFER, JAXINTA SILVIA (LCSW)
Entity Type:Individual
Prefix:
First Name:JAXINTA
Middle Name:SILVIA
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1011
Mailing Address - Country:US
Mailing Address - Phone:480-326-5006
Mailing Address - Fax:
Practice Address - Street 1:104 E GARFIELD ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1011
Practice Address - Country:US
Practice Address - Phone:480-326-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW18021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health