Provider Demographics
NPI:1306914338
Name:SHORE PSYCHOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:SHORE PSYCHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-292-0388
Mailing Address - Street 1:200 ATLANTIC AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1352
Mailing Address - Country:US
Mailing Address - Phone:732-292-0388
Mailing Address - Fax:732-292-0399
Practice Address - Street 1:200 ATLANTIC AVE
Practice Address - Street 2:SUITE K
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1352
Practice Address - Country:US
Practice Address - Phone:732-292-0388
Practice Address - Fax:732-292-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00385000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty