Provider Demographics
NPI:1902232291
Name:SHEPERD RIOLO, KELLY ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:SHEPERD RIOLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 MARLEIGH CIR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2206
Mailing Address - Country:US
Mailing Address - Phone:908-770-1858
Mailing Address - Fax:
Practice Address - Street 1:3901 GREENSPRING AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1353
Practice Address - Country:US
Practice Address - Phone:443-923-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist