Provider Demographics
NPI:1477268217
Name:SHAFFER, CATHERINE (LSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:7651 SHADY WATER LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3686
Mailing Address - Country:US
Mailing Address - Phone:937-604-8119
Mailing Address - Fax:
Practice Address - Street 1:4977 NORTHCUTT PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3839
Practice Address - Country:US
Practice Address - Phone:800-829-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185154101YA0400X
OHS2411056104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)