Provider Demographics
NPI:1801104476
Name:SHORE, STUART (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:SHORE
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 STUMP RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9645
Mailing Address - Country:US
Mailing Address - Phone:215-264-3839
Mailing Address - Fax:
Practice Address - Street 1:418 STUMP RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9645
Practice Address - Country:US
Practice Address - Phone:215-264-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional