Provider Demographics
NPI:1548366651
Name:SHIPHERD, JILLIAN CARROLL (PHD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:CARROLL
Last Name:SHIPHERD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:97 WELLSMERE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4123
Mailing Address - Country:US
Mailing Address - Phone:617-232-9500
Mailing Address - Fax:857-364-4515
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:VA HOSPITAL WOMEN'S HEALTH SCIENCES (116B3)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:617-232-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical