=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588065544
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW PERSPECTIVE CLINICAL SERVICES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2014
-----------------------------------------------------
Last Update Date | 09/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 MAIN ST
-----------------------------------------------------
City | EAST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06512-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-927-5130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 MAIN ST
-----------------------------------------------------
City | EAST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06512-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-927-5130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ERIN E MCCORMACK
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 203-927-5130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 006565
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------