Provider Demographics
NPI:1518924505
Name:SHEPARDSON, ELIZABETH A (MED CAS)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:SHEPARDSON
Suffix:
Gender:F
Credentials:MED CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1814
Mailing Address - Country:US
Mailing Address - Phone:413-525-2650
Mailing Address - Fax:413-525-2657
Practice Address - Street 1:280 N MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1814
Practice Address - Country:US
Practice Address - Phone:413-525-2650
Practice Address - Fax:413-525-2657
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist