Provider Demographics
NPI:1033317649
Name:SHEPARD, SARAH A (LICSW)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:A
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RAYMOND ST
Mailing Address - Street 2:#7
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3977
Mailing Address - Country:US
Mailing Address - Phone:978-335-5599
Mailing Address - Fax:
Practice Address - Street 1:4 RAYMOND ST
Practice Address - Street 2:#7
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3977
Practice Address - Country:US
Practice Address - Phone:978-335-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2140011041C0700X
MA1156231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical