Provider Demographics
NPI:1043377070
Name:SHEPHERD, CALEB JOHN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:JOHN
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 NEW BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-9681
Mailing Address - Country:US
Mailing Address - Phone:802-778-0941
Mailing Address - Fax:
Practice Address - Street 1:320 MAIN ST # 3A
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-4418
Practice Address - Country:US
Practice Address - Phone:802-778-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900011771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT089-0001177OtherLICSW
MA110290OtherLICSW