Provider Demographics
NPI:1164720348
Name:SHEPPARD, KRISTEN L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-5760
Mailing Address - Country:US
Mailing Address - Phone:978-373-1181
Mailing Address - Fax:978-374-7605
Practice Address - Street 1:76 WINTER STREET
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-0000
Practice Address - Country:US
Practice Address - Phone:978-373-1181
Practice Address - Fax:978-374-7605
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2141351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1083748230Medicaid