Provider Demographics
NPI:1144415886
Name:KEPES, SHERWIN Y (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERWIN
Middle Name:Y
Last Name:KEPES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7639
Mailing Address - Country:US
Mailing Address - Phone:260-749-8419
Mailing Address - Fax:260-749-0335
Practice Address - Street 1:6026 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7639
Practice Address - Country:US
Practice Address - Phone:260-749-8419
Practice Address - Fax:260-749-0335
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN138690Medicare PIN