Doctor Name: | KRISTEN N. SHEPPARD |
NPI Number: | 1013391325 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW-CC |
License Number: | MC15432 |
Business Practice Address: | 81 Main St. Ste: 401 Bangor, ME - 04401 |
Business Phone Number: | 2072662669 |
Business Fax Number: | 2076312203 |
Mailing Address: | 81 Main St., Ste: 401 BANGOR |
State: | ME |
Postal Code: | 04401 |
Phone Number: | 2072662669 |
Fax Number: | 2076312203 |
NPI Enumeration Date: | 07/16/2015 |
NPI Last Update Date: | 07/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | MC15432 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |