Healthcare Provider Details

I. General information

NPI: 1801143425
Provider Name (Legal Business Name): M.HARI SHEPPEARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 4TH ST NW STE 102
ALBUQUERQUE NM
87102-2104
US

IV. Provider business mailing address

500 4TH ST NW STE 102
ALBUQUERQUE NM
87102-2104
US

V. Phone/Fax

Practice location:
  • Phone: 505-810-2098
  • Fax:
Mailing address:
  • Phone: 505-810-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09344
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: