Provider Demographics
NPI:1891969192
Name:SHEPARD, JULIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:103 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2803
Mailing Address - Country:US
Mailing Address - Phone:410-271-6272
Mailing Address - Fax:
Practice Address - Street 1:103 BALSAM DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2803
Practice Address - Country:US
Practice Address - Phone:410-271-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-07-3394103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral