MEDICARE: MRS. LEILA M. SHEPARD LPC

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	101YP2500X	Professional Counselor	000185	CT

General Provider Information

NPI Number	:	1942404645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEILA M. SHEPARD LPC

Provider Business Mailing Address
First Line	:	21 CHICAGO AVE
Second Line	:
City	:	GROTON
State	:	CT
Zip	:	06340-4907
Country	:	US
Telephone Number	:	860-437-2188
Fax Number	:	860-449-5791

Provider Business Practice Location Address
First Line	:	21 CHICAGO AVE
Second Line	:
City	:	GROTON
State	:	CT
Zip	:	06340-4907
Country	:	US
Telephone Number	:	860-437-2188
Fax Number	:	860-449-5791

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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