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General NPI Number Information
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NPI Number | 1144559881
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE PSYCHOLOGICAL CARE P.C.
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 250 MONTAUK HIGHWAY
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City | EAST MORICHES
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State | NY
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Zip | 11940
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Country | US
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Telephone | 631-786-8930
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Fax | 631-874-2824
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Provider Business Mailing Address
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Address Line | 250 MONTAUK HIGHWAY
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City | EAST MORICHES
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State | NY
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Zip | 11940
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Country | US
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Telephone | 631-786-8930
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Fax | 631-874-2824
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Authorized Official
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Title or Position | PSYCHOLOGIST-PRESIDENT
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Name | DR. PETER G D'ELENA
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Credential | PSY.D.
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Telephone | 631-786-8930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015937
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License Number State | NY
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