Provider Demographics
NPI:1699434258
Name:SHAPING AFFINITY LLC
Entity type:Organization
Organization Name:SHAPING AFFINITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:GIAMMANCHERI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:985-414-2491
Mailing Address - Street 1:2525 PINERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3976
Mailing Address - Country:US
Mailing Address - Phone:985-414-2491
Mailing Address - Fax:
Practice Address - Street 1:2525 PINERIDGE ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3976
Practice Address - Country:US
Practice Address - Phone:985-414-2491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty