Individual
DR. JONATHAN SHAFFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
019151
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13862744
CAQH
CO
01
—
PSY.0004404
PROFESSIONAL LICENSE
CO
Enumeration date
10/04/2011
Last updated
08/01/2016
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