Provider Demographics
NPI:1073770996
Name:SHORE, ROSALIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:
Last Name:SHORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:SHORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:122 W 27TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6227
Mailing Address - Country:US
Mailing Address - Phone:212-255-8980
Mailing Address - Fax:646-365-5730
Practice Address - Street 1:122 W 27TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6227
Practice Address - Country:US
Practice Address - Phone:212-255-8980
Practice Address - Fax:646-365-5730
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor