Active NPI
Cynthia Popelka Shepard, LMFT
- Marriage & Family Therapist
- San Pedro, CA
National Provider Identifier
1396951778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT24609
- Practice address
- 2403 S Moray Ave Ste 3
San Pedro, CA 90732-4323 - Phone
- (310) 547-1485
- NPI assigned
- May 15, 2007
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT24609 | CA | Primary |
Addresses
Primary practice location
2403 S Moray Ave Ste 3
San Pedro, CA 90732-4323
Mailing address
1621 W 25TH St # 152
San Pedro, CA 90732-4301
Phone (310) 547-1485
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24609 | Other | CA | MFT LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 6, 2024 through Feb 6, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT24609 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735430400000",
"number": "1396951778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 W 25TH ST # 152",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907324301",
"telephone_number": "310-547-1485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2403 S MORAY AVE STE 3",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907324323",
"telephone_number": "310-547-1485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPARD",
"first_name": "CYNTHIA",
"middle_name": "POPELKA",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2024-12-29",
"certification_date": "2024-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT24609",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MFT LICENSE #",
"identifier": "24609",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.