Provider Demographics
NPI:1013391325
Name:SHEPPARD, KRISTEN N (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BURNHAM HILL RD STE 401
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:ME
Mailing Address - Zip Code:04941-3313
Mailing Address - Country:US
Mailing Address - Phone:207-270-1970
Mailing Address - Fax:
Practice Address - Street 1:12 BURNHAM HILL RD STE 401
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:ME
Practice Address - Zip Code:04941-3313
Practice Address - Country:US
Practice Address - Phone:207-270-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC179761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical