Provider Demographics
NPI:1699423517
Name:SHAFFER, KATHARINE SUZANNE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:SUZANNE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CHASE ST STE 214
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-7402
Mailing Address - Country:US
Mailing Address - Phone:410-231-3109
Mailing Address - Fax:
Practice Address - Street 1:1 E CHASE ST STE 214
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-7402
Practice Address - Country:US
Practice Address - Phone:410-231-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06725103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling