Basic Information
| Provider Information | |||||||||
| NPI: | 1356411888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAFER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | JOHNSON | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 389 RAMBLE RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913602850 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 NEWBURY RD | ||||||||
| Address2: | #240 | ||||||||
| City: | NEWBURY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913206435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054981400 | ||||||||
| FaxNumber: | 8054981411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 16945 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.