1871587527 NPI number — SOUTH SHORE COUNSELING SERVICES OF CERTIFIED SOCIAL WORKERS, PLLC

Table of content: (NPI 1871587527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871587527 NPI number — SOUTH SHORE COUNSELING SERVICES OF CERTIFIED SOCIAL WORKERS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE COUNSELING SERVICES OF CERTIFIED SOCIAL WORKERS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871587527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 4TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-7962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-665-6244
Provider Business Mailing Address Fax Number:
631-968-6169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 4TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-7962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-665-6244
Provider Business Practice Location Address Fax Number:
631-968-6169
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VIGLIOTTA
Authorized Official First Name:
PETER
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER/SOCIAL WORK THERAPIST
Authorized Official Telephone Number:
631-665-6244

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R046965-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: R043922-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: R040607-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02246913 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02247547 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02218862 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02681721 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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