Provider Demographics
NPI:1437750585
Name:SHOREY, ERIC GRANT (LP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:GRANT
Last Name:SHOREY
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 JEWEL ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3025
Mailing Address - Country:US
Mailing Address - Phone:516-376-2687
Mailing Address - Fax:
Practice Address - Street 1:91 JEWEL ST APT 3R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-3025
Practice Address - Country:US
Practice Address - Phone:516-376-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001080102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst