=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447018312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEASHELL COUNSELING ,LCSW, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2024
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 FRANKLIN AVE STE 215
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-5815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-750-8883
-----------------------------------------------------
Fax | 516-750-5930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 E PINE ST
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11561-2334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-639-2654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RANDI SHELOWITZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 516-639-2654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------