Provider Demographics
NPI:1154975423
Name:SHEPHERD, SIRINA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SIRINA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SIRINA
Other - Middle Name:
Other - Last Name:RAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N14W23777 STONE RIDGE DR STE 135
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1164
Mailing Address - Country:US
Mailing Address - Phone:414-446-0751
Mailing Address - Fax:
Practice Address - Street 1:N14W23777 STONE RIDGE DR STE 135
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1164
Practice Address - Country:US
Practice Address - Phone:414-446-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI131277-121104100000X
WI99821231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker