Active NPI
Judith Shaffer, LCSW, LICSW
- Clinical Social Worker
- San Rafael, CA
National Provider Identifier
1740765106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS16364
- Practice address
- 108 Maywood Way
San Rafael, CA 94901-1132 - Phone
- (415) 459-6533
- NPI assigned
- Oct 1, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS16364 | CA | Primary |
Addresses
Primary practice location
108 Maywood Way
San Rafael, CA 94901-1132
Mailing address
108 Maywood Way
San Rafael, CA 94901-1132
Phone (415) 459-6533
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 |
|---|---|---|---|
| LCS16364 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538352000000",
"number": "1740765106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 MAYWOOD WAY",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949011132",
"telephone_number": "415-459-6533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 MAYWOOD WAY",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949011132",
"telephone_number": "415-459-6533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "JUDITH",
"name_prefix": "Ms.",
"credential": "LCSW, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-01",
"last_updated": "2018-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS16364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.