Provider Demographics
NPI:1366216343
Name:SHEPPARD, JANETTE J (LCADC, LSW, CCS)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:J
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LCADC, LSW, CCS
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:J
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2630
Mailing Address - Country:US
Mailing Address - Phone:201-776-4058
Mailing Address - Fax:
Practice Address - Street 1:134 S SHORE DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2630
Practice Address - Country:US
Practice Address - Phone:201-776-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06234800104100000X
NJ37LC00247600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker