Healthcare Provider Details

I. General information

NPI: 1255327391
Provider Name (Legal Business Name): SOUTH SHORE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705A OLD POST RD
CHARLESTOWN RI
02813-1819
US

IV. Provider business mailing address

PO BOX 899
CHARLESTOWN RI
02813-0899
US

V. Phone/Fax

Practice location:
  • Phone: 401-364-7705
  • Fax: 401-364-9104
Mailing address:
  • Phone: 401-364-7705
  • Fax: 401-364-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY A YEAMEN
Title or Position: COO
Credential: MPA
Phone: 401-364-7705