Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3874 | NJ |
Y | 103TC0700X | Clinical Psychologist | 3874 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3874 | NJ |
N | 103TM1800X | Intellectual & Developmental Disabilities | 3874 | NJ |
N | 103TS0200X | School Psychologist | 3874 | NJ |
NPI | 1104041664 |
---|---|
Provider Name | Dr. Matthew Warren Sheprow |
First Address | Sea Girt, NJ 08750-1813 |
Second Address | Wall Township, NJ 07719-9693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 13/10/2011 |