Provider Demographics
NPI:1407493828
Name:SHORE PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:SHORE PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:REIDER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:443-249-3162
Mailing Address - Street 1:112 SAINT CLAIRE PL STE 202
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2193
Mailing Address - Country:US
Mailing Address - Phone:443-249-3162
Mailing Address - Fax:
Practice Address - Street 1:112 SAINT CLAIRE PL STE 202
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2193
Practice Address - Country:US
Practice Address - Phone:443-249-3162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty