Provider Demographics
NPI:1679621148
Name:SCHAFFER, ROBERTA (LCSWR)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7616
Mailing Address - Country:US
Mailing Address - Phone:914-848-8030
Mailing Address - Fax:914-848-8031
Practice Address - Street 1:143 N BROADWAY
Practice Address - Street 2:APT. 2
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3602
Practice Address - Country:US
Practice Address - Phone:914-525-9012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0562861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY242273OtherHEALTHNET
NY140056286NY01OtherANTHEM
NY140056286NY01OtherANTHEM