Provider Demographics
NPI:1144411968
Name:SHEPPARD, LYNN ROSE (LICSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ROSE
Last Name:SHEPPARD
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:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-0335
Mailing Address - Country:US
Mailing Address - Phone:508-378-9000
Mailing Address - Fax:508-378-9001
Practice Address - Street 1:11 MAPLE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1547
Practice Address - Country:US
Practice Address - Phone:508-378-9000
Practice Address - Fax:508-378-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical