Provider Demographics
NPI:1073096053
Name:SHEPHERD, LINDA V (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:V
Last Name:SHEPHERD
Suffix:
Gender:F
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-0312
Mailing Address - Country:US
Mailing Address - Phone:808-209-4323
Mailing Address - Fax:
Practice Address - Street 1:8235 SANTA MONICA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5969
Practice Address - Country:US
Practice Address - Phone:888-684-2779
Practice Address - Fax:323-366-2966
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist