Provider Demographics
NPI:1760698476
Name:SHORR, MADELYN ETHEL (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:ETHEL
Last Name:SHORR
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BROWNING TER
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4312
Mailing Address - Country:US
Mailing Address - Phone:845-514-2106
Mailing Address - Fax:
Practice Address - Street 1:18 BROWNING TER
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4312
Practice Address - Country:US
Practice Address - Phone:845-514-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01052711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical