Provider Demographics
NPI:1023592375
Name:SHEPPARD, CAROLYN RUTH (LICSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:RUTH
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MCDEVITT RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3850
Mailing Address - Country:US
Mailing Address - Phone:774-274-0311
Mailing Address - Fax:
Practice Address - Street 1:35 MCDEVITT RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3850
Practice Address - Country:US
Practice Address - Phone:774-274-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10197901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical