Provider Demographics
NPI:1770774721
Name:SHEPHERD, ELIZABETH J (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 AMBLE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1906
Mailing Address - Country:US
Mailing Address - Phone:207-944-9011
Mailing Address - Fax:
Practice Address - Street 1:23 AMBLE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1906
Practice Address - Country:US
Practice Address - Phone:207-944-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9641103TC2200X
NH1246103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent