Raevan Monica Shepherd, ASW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

118333 Issued in CA

Practice address

9055 Hwy 53
Lower Lake, CA 95422-8458

Phone

(707) 994-7090

NPI assigned

Feb 27, 2018

Last updated

Oct 7, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sacred Life Recovery Services

  • Addiction (Substance Use Disorder) Counselor
  • Lakeport, CA
  • NPI 1750119061
  NPD Authorized official
• Ford Street Project

  dba Ukiah Recovery Center

  • Substance Abuse Rehabilitation Facility
  • Ukiah, CA
  • NPI 1073946547
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759795200000",
    "number": "1053812883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2681 LAKESHORE BLVD APT 7",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536971",
            "telephone_number": "707-295-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9055 HWY 53",
            "city": "LOWER LAKE",
            "state": "CA",
            "postal_code": "954228458",
            "telephone_number": "707-994-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "RAEVAN",
        "middle_name": "MONICA",
        "credential": "ASW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-27",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "118333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Joseph Miner, DC
• Optimum Wellness Group Inc
• Ruth Richards, L.AC.
• Constance Jean Rock, L.M., C.P.M.
• Carolynn Rosen, LCSW
• Tim Sherrell, LCSW
• Manuella Smoley, MS, CCC-SLP
• Shannon Trout
• Annunziata Johanna Paulina Van Voorene, LCSW
• Adriaan Francois Van Wyk, LMFT

• Clinical Social Worker in Lower Lake, CA
• Providers in Lower Lake, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.