Provider Demographics
NPI:1851550685
Name:SHOREY, LISA M (MHRT-II)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SHOREY
Suffix:
Gender:F
Credentials:MHRT-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2817
Mailing Address - Country:US
Mailing Address - Phone:207-768-3304
Mailing Address - Fax:207-764-6340
Practice Address - Street 1:162 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2817
Practice Address - Country:US
Practice Address - Phone:207-768-3304
Practice Address - Fax:207-764-6340
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000OtherMAINE CARE