Individual provider Active NPI

Matthew Warren Sheprow, PH.D.

  • Clinical Psychologist
  • Wall Township, NJ
National Provider Identifier
1104041664
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3874 Issued in NJ
Practice address
3350 State Route 138
BLDG 1, Suite 117
Wall Township, NJ 07719-9693
Phone
(732) 681-2345
NPI assigned
Apr 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3874 NJ Primary
Clinical Child & Adolescent Psychologist 103TC2200X 3874 NJ
Intellectual & Developmental Disabilities Psychologist 103TM1800X 3874 NJ
School Psychologist 103TS0200X 3874 NJ

Addresses

Primary practice location

3350 State Route 138
BLDG 1, Suite 117
Wall Township, NJ 07719-9693

Mailing address

2158 Terrace PL
Sea Girt, NJ 08750-1813
Phone (732) 681-2345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120606000022 NJ Practitioner - Clinical Psychologist 8820252760 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
3874NJMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Challenges Psychological Services, P.a. CurrentSince Mar 17, 2012 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1104041664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2158 TERRACE PL",
            "city": "SEA GIRT",
            "state": "NJ",
            "postal_code": "087501813",
            "telephone_number": "732-681-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 STATE ROUTE 138",
            "address_2": "BLDG 1, SUITE 117",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199693",
            "telephone_number": "732-681-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPROW",
        "first_name": "MATTHEW",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "3874",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NJ",
            "license": "3874",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NJ",
            "license": "3874",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NJ",
            "license": "3874",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wall Township, NJ

Sources for this page

Verify at the official NPI Registry.