Provider Demographics
NPI:1881927226
Name:SHEPHERD, KATHRYN BOWIE
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:BOWIE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WHITE BIRCH TRL
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-4624
Mailing Address - Country:US
Mailing Address - Phone:631-723-9957
Mailing Address - Fax:
Practice Address - Street 1:225 W MONTAUK HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-3531
Practice Address - Country:US
Practice Address - Phone:631-723-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health