Provider Demographics
NPI:1730345182
Name:SHOR, ELIZABETH (LICSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:SHOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 HUYETT RD
Mailing Address - Street 2:THE MENTAL AND SOCIAL HEALTH CENTER
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5378
Mailing Address - Country:US
Mailing Address - Phone:304-997-4161
Mailing Address - Fax:
Practice Address - Street 1:667 HUYETT RD
Practice Address - Street 2:THE MENTAL AND SOCIAL HEALTH CENTER
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5378
Practice Address - Country:US
Practice Address - Phone:304-997-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009432371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013376Medicaid