Provider Demographics
NPI:1053644369
Name:SHEPARDSON, ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SHEPARDSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HOLLAND ST
Mailing Address - Street 2:ROOM 133
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2401
Mailing Address - Country:US
Mailing Address - Phone:617-629-6668
Mailing Address - Fax:617-625-6339
Practice Address - Street 1:167 HOLLAND ST
Practice Address - Street 2:ROOM 133
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2401
Practice Address - Country:US
Practice Address - Phone:617-629-6668
Practice Address - Fax:617-625-6339
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10171871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical