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General NPI Number Information
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NPI Number | 1023497302
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Entity Type | Organization
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Legal Business Name | SHORELINE PSYCHIATRIC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 226 E MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3103
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Country | US
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Telephone | 203-871-1357
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Fax | 203-488-5034
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Provider Business Mailing Address
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Address Line | 226 E MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3103
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Country | US
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Telephone | 203-871-1357
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Fax | 203-488-5034
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHLEEN MARIE LAZZARINI
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Credential | M.D.
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Telephone | 203-871-1357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 034237
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License Number State | CT
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