Provider Demographics
NPI:1053690461
Name:SHAFER, ADAM LLOYD (PSYD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LLOYD
Last Name:SHAFER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1520
Mailing Address - Country:US
Mailing Address - Phone:708-537-9951
Mailing Address - Fax:
Practice Address - Street 1:820 W JACKSON BLVD STE 515
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3061
Practice Address - Country:US
Practice Address - Phone:708-537-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical