Healthcare Provider Details

I. General information

NPI: 1184533697
Provider Name (Legal Business Name): SOUTH SHORE GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CHURCH ST
FREEPORT NY
11520-3833
US

IV. Provider business mailing address

916 WALLACE AVE
NORTH BALDWIN NY
11510-2147
US

V. Phone/Fax

Practice location:
  • Phone: 516-868-3030
  • Fax:
Mailing address:
  • Phone: 347-752-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: TRINA RIVERS
Title or Position: SCHOOL WORKER INTERN
Credential:
Phone: 347-752-7834