Provider Demographics
NPI:1952767097
Name:SHAFFER, ERIN BRIANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:BRIANA
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 KENWOOD AVENUE
Mailing Address - Street 2:EVANS PROFESSIONAL BUILDING SUITE 2A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4918
Mailing Address - Country:US
Mailing Address - Phone:410-687-7700
Mailing Address - Fax:410-687-7702
Practice Address - Street 1:6304 KENWOOD AVENUE
Practice Address - Street 2:EVANS PROFESSIONAL BUILDING SUITE 2A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4918
Practice Address - Country:US
Practice Address - Phone:410-687-7700
Practice Address - Fax:410-687-7702
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR13034Medicare UPIN