Provider Demographics
NPI:1124411822
Name:SHEPARD, LENORE (LICSW)
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:
Last Name:SHEPARD
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 1:176 WINTHROP RD
Mailing Address - Street 2:APT 8
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4688
Mailing Address - Country:US
Mailing Address - Phone:917-406-5415
Mailing Address - Fax:
Practice Address - Street 1:176 WINTHROP RD
Practice Address - Street 2:APARTMENT 8
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4688
Practice Address - Country:US
Practice Address - Phone:917-406-5415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA074973-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical