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General NPI Number Information
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NPI Number | 1124569157
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Entity Type | Organization
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Legal Business Name | SHORELINE NEUROPSYCHIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 99 WHITFIELD ST
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City | GUILFORD
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State | CT
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Zip | 06437-3429
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Country | US
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Telephone | 203-244-3443
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Fax | 860-261-0669
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Provider Business Mailing Address
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Address Line | 6209 KNIGHTSGATE CT
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City | CHARLOTTE
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State | NC
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Zip | 28269-0603
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Country | US
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Telephone | 203-693-1510
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Fax | 938-253-3590
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE JAMIE STEVENS
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Credential | PMHNP
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Telephone | 203-693-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12.004567
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License Number State | CT
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