Provider Demographics
NPI:1407069065
Name:SHORE, BARBARA S (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:S
Last Name:SHORE
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 7TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2629
Mailing Address - Country:US
Mailing Address - Phone:310-403-8675
Mailing Address - Fax:310-862-1886
Practice Address - Street 1:1460 7TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2629
Practice Address - Country:US
Practice Address - Phone:310-403-8675
Practice Address - Fax:310-862-1886
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMS24655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMS24655OtherMFT LISCENSE