Healthcare Provider Details

I. General information

NPI: 1053695874
Provider Name (Legal Business Name): CHRISTINE SHORE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE SHORE LPC-A

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CAPTAIN THOMAS BLVD APT 202
WEST HAVEN CT
06516-8923
US

IV. Provider business mailing address

256 CAPTAIN THOMAS BLVD APT 202
WEST HAVEN CT
06516-8923
US

V. Phone/Fax

Practice location:
  • Phone: 203-693-1550
  • Fax:
Mailing address:
  • Phone: 203-693-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8651
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA17070
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: