Healthcare Provider Details

I. General information

NPI: 1982906186
Provider Name (Legal Business Name): SHORE RESOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HIGH ST.
CAMBRIDGE MD
21613-1816
US

IV. Provider business mailing address

211 HIGH ST.
CAMBRIDGE MD
21613-1816
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-4357
  • Fax:
Mailing address:
  • Phone: 410-228-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number14584
License Number StateMD

VIII. Authorized Official

Name: LISA ANN BRENNER
Title or Position: OWNER/ THERAPIST
Credential: LCSW-C
Phone: 410-228-4357