Provider Demographics
NPI:1669501037
Name:SHEPARD, GAYE WEIN (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:GAYE
Middle Name:WEIN
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:DR
Other - First Name:GAYE
Other - Middle Name:
Other - Last Name:WEIN-SHEPARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW,PHD
Mailing Address - Street 1:420 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3556
Mailing Address - Country:US
Mailing Address - Phone:626-796-2593
Mailing Address - Fax:
Practice Address - Street 1:275 E CALIFORNIA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3615
Practice Address - Country:US
Practice Address - Phone:626-585-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS12484174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist