Provider Demographics
NPI:1770973299
Name:SHAFFER, MICHELE (LICSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GREENBRIAR DR
Mailing Address - Street 2:307
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-3148
Mailing Address - Country:US
Mailing Address - Phone:857-225-0395
Mailing Address - Fax:
Practice Address - Street 1:4 GREENBRIAR DR
Practice Address - Street 2:307
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-3148
Practice Address - Country:US
Practice Address - Phone:857-225-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical