Provider Demographics
NPI:1740565647
Name:SHORES, KRISTEN M (LISW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:SHORES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:CIPRIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:640 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1413
Mailing Address - Country:US
Mailing Address - Phone:330-762-5425
Mailing Address - Fax:330-777-4935
Practice Address - Street 1:640 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1413
Practice Address - Country:US
Practice Address - Phone:330-762-5425
Practice Address - Fax:330-777-4935
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI07002171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
H183680Medicare UPIN