MEDICARE: CHRISTINE SHORE MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8651	CT
2	101YP2500X	Professional Counselor	A17070	NC

General Provider Information

NPI Number	:	1053695874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE SHORE MS

Provider Business Mailing Address
First Line	:	256 CAPTAIN THOMAS BLVD APT 202
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-8923
Country	:	US
Telephone Number	:	203-693-1550
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 CAPTAIN THOMAS BLVD APT 202
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-8923
Country	:	US
Telephone Number	:	203-693-1550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	12/15/2025

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Directions to “ CHRISTINE SHORE MS” Practice Location

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