Active NPI
Jane Kirstine Shepard, PSY.D.
- Psychologist
- New Haven, CT
National Provider Identifier
1497963656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 002365
- Practice address
- 357 Whitney Ave
Suite G-01
New Haven, CT 06511-2364 - Phone
- (203) 676-8997
- Fax
- (203) 787-9744
- NPI assigned
- May 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 002365 | CT | Primary |
Addresses
Primary practice location
357 Whitney Ave
Suite G-01
New Haven, CT 06511-2364
Mailing address
357 Whitney Ave
Suite G-01
New Haven, CT 06511-2364
Phone (203) 676-8997
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11244570 | Other | CT | CAQH |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002365 | CT | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218499200000",
"number": "1497963656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "357 WHITNEY AVE",
"address_2": "SUITE G-01",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065112364",
"telephone_number": "203-676-8997",
"fax_number": "203-787-9744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "357 WHITNEY AVE",
"address_2": "SUITE G-01",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065112364",
"telephone_number": "203-676-8997",
"fax_number": "203-787-9744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPARD",
"first_name": "JANE",
"middle_name": "KIRSTINE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-20",
"last_updated": "2008-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CT",
"license": "002365",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11244570",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.