Basic Information
| Provider Information | |||||||||
| NPI: | 1518924505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPARDSON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.ED CAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 N MAIN ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010281814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135252650 | ||||||||
| FaxNumber: | 4135252657 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 N MAIN ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010281814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135252650 | ||||||||
| FaxNumber: | 4135252657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1139 | MA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.