Active NPI
Susan J Shepherd, LICSW
- Clinical Social Worker
- Brattleboro, VT
National Provider Identifier
1043304231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0890000448
- Practice address
- 22 Whipple St
Brattleboro, VT 05301-6080 - Phone
- (802) 254-5497
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0890000448 | VT | Primary |
Addresses
Primary practice location
22 Whipple St
Brattleboro, VT 05301-6080
Mailing address
22 Whipple St
Brattleboro, VT 05301-6080
Phone (802) 254-5497
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08028628 | Other | BCBS | |
| 1007083 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0890000448 | VT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043304231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 WHIPPLE ST",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "053016080",
"telephone_number": "802-254-5497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 WHIPPLE ST",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "053016080",
"telephone_number": "802-254-5497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "SUSAN",
"middle_name": "J",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VT",
"license": "0890000448",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "08028628",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007083",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brattleboro, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.