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General NPI Number Information
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NPI Number | 1235229030
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Entity Type | Organization
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Legal Business Name | SOUTHSHORE COUPLES & FAMILY COUNSELING CENTER
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 143 E PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-3522
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Country | US
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Telephone | 516-431-3130
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Fax | 516-431-3130
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Provider Business Mailing Address
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Address Line | 143 E PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-3522
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Country | US
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Telephone | 516-431-3130
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Fax | 516-431-3130
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MARY ANN UNGERSON
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Credential | MA
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Telephone | 516-431-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000163
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License Number State | NY
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