MEDICARE: KATHLEEN SHEPHERD MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1659727352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SHEPHERD MSW

Provider Business Mailing Address
First Line	:	1320 N VEITCH ST
Second Line	:	1813
City	:	ARLINGTON
State	:	VA
Zip	:	22201-6221
Country	:	US
Telephone Number	:	703-475-1727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 N VEITCH ST
Second Line	:	1813
City	:	ARLINGTON
State	:	VA
Zip	:	22201-6221
Country	:	US
Telephone Number	:	703-475-1727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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Directions to “ KATHLEEN SHEPHERD MSW” Practice Location

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