Healthcare Provider Details

I. General information

NPI: 1366358467
Provider Name (Legal Business Name): SOUTH SHORE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 GLASGOW RD
WILLIAMSTOWN NJ
08094-2942
US

IV. Provider business mailing address

31 GLASGOW RD
WILLIAMSTOWN NJ
08094-2942
US

V. Phone/Fax

Practice location:
  • Phone: 856-625-3021
  • Fax:
Mailing address:
  • Phone: 856-625-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. LUCY OMONUWA MOMODU
Title or Position: SOLE MEMBER / OWNER
Credential: PMHNP-BC, APN, RN
Phone: 856-625-3021