Provider Demographics
NPI:1447708383
Name:SHEPHERD, HERMAYA (LSW)
Entity type:Individual
Prefix:
First Name:HERMAYA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 IRVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4408
Mailing Address - Country:US
Mailing Address - Phone:216-536-4726
Mailing Address - Fax:
Practice Address - Street 1:3714 IRVING PARK AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4408
Practice Address - Country:US
Practice Address - Phone:216-536-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1600881104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker