Provider Demographics
NPI:1477563534
Name:SHORE PSYCHOLOGICAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:SHORE PSYCHOLOGICAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-920-3434
Mailing Address - Street 1:220 JACK MARTIN BOULVARD
Mailing Address - Street 2:SUITE E2
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-920-3434
Mailing Address - Fax:732-920-2447
Practice Address - Street 1:220 JACK MARTIN BOULVARD
Practice Address - Street 2:SUITE E2
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-920-3434
Practice Address - Fax:732-920-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty