Individual
DR. JONATHAN SHAFFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
6121 W 60TH AVE, ARVADA, CO 80003-5603
(303) 420-4550
Mailing address
4860 ROBB ST, SUITE 201, WHEAT RIDGE, CO 80033-2184
(303) 278-7418
(303) 223-9315
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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