Provider Demographics
NPI:1679862320
Name:SHOR, BARBARA (SLP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:SHOR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SEAMAN RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1610
Mailing Address - Country:US
Mailing Address - Phone:516-938-0251
Mailing Address - Fax:
Practice Address - Street 1:112 SEAMAN RD
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1610
Practice Address - Country:US
Practice Address - Phone:516-938-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008937-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional