Active NPI
Cory Ian Shafer, LPC
- Professional Counselor
- Kingston, PA
National Provider Identifier
1124364229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC005347
- Practice address
- 675 Wyoming Ave
Kingston, PA 18704-3831 - Phone
- (570) 332-2093
- NPI assigned
- Dec 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC005347 | PA | Primary |
Addresses
Primary practice location
675 Wyoming Ave
Kingston, PA 18704-3831
Mailing address
102 N Welles Ave
Kingston, PA 18704-5142
Phone (570) 905-4738
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC005347 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450828800000",
"number": "1124364229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 N WELLES AVE",
"city": "KINGSTON",
"state": "PA",
"postal_code": "187045142",
"telephone_number": "570-905-4738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 WYOMING AVE",
"city": "KINGSTON",
"state": "PA",
"postal_code": "187043831",
"telephone_number": "570-332-2093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFER",
"first_name": "CORY",
"middle_name": "IAN",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-17",
"last_updated": "2015-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC005347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingston, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.