Provider Demographics
NPI:1770260135
Name:SHEPPARD, REBECCA (LSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 SEAN HAGGERTY DR APT 17209
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3446
Mailing Address - Country:US
Mailing Address - Phone:215-870-7761
Mailing Address - Fax:
Practice Address - Street 1:11210 SEAN HAGGERTY DR APT 17209
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3446
Practice Address - Country:US
Practice Address - Phone:215-870-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137430104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker