Provider Demographics
NPI:1154582948
Name:SHEAFFER, ROBERTA R (LSW)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:R
Last Name:SHEAFFER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16804-0802
Mailing Address - Country:US
Mailing Address - Phone:814-360-8762
Mailing Address - Fax:814-237-7480
Practice Address - Street 1:219 W HIGH ST
Practice Address - Street 2:LOFT 11
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1301
Practice Address - Country:US
Practice Address - Phone:814-360-8762
Practice Address - Fax:814-237-7480
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW9855L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker