Healthcare Provider Details

I. General information

NPI: 1205972601
Provider Name (Legal Business Name): SOUTH SHORE CHILD ASSOCIATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CHURCH STREET
FREEPORT NY
11520-3731
US

IV. Provider business mailing address

114 CHURCH STREET
FREEPORT NY
11520-3731
US

V. Phone/Fax

Practice location:
  • Phone: 516-868-3030
  • Fax: 516-868-3374
Mailing address:
  • Phone: 516-868-3030
  • Fax: 516-868-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number160310993
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number080310993
License Number StateNY

VIII. Authorized Official

Name: NATALIE M RICHMAN
Title or Position: REVENUE MANAGEMENT ADMINISTRATOR
Credential:
Phone: 516-739-7733