Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 10290 | MA |
NPI | 1043706419 |
---|---|
Provider Name | Dr. Jessica Shepley |
First Address | Bernardston, MA 01337-9586 |
Second Address | Bernardston, MA 01337-9586 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2018 |
Last Update Date | 09/07/2018 |