Provider Demographics
NPI:1336999762
Name:SHEPARD, EMILY (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 TROY SCHENECTADY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1000
Mailing Address - Country:US
Mailing Address - Phone:518-400-5180
Mailing Address - Fax:518-940-4420
Practice Address - Street 1:1182 TROY SCHENECTADY RD STE 204
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1000
Practice Address - Country:US
Practice Address - Phone:518-400-5180
Practice Address - Fax:518-940-4420
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health