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General NPI Number Information
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NPI Number | 1750927802
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Entity Type | Organization
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Legal Business Name | SHORELINE PSYCHOLOGICAL
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 17A WOODLAND RD
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City | MADISON
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State | CT
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Zip | 06443-2342
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Country | US
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Telephone | 203-779-5490
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Fax | 203-896-9830
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Provider Business Mailing Address
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Address Line | 17A WOODLAND RD
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City | MADISON
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State | CT
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Zip | 06443-2342
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Country | US
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Telephone | 203-779-5490
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Fax | 203-896-9830
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. ABBY LIPSCHUTZ
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Credential | PSY.D.
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Telephone | 646-265-2850
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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 |
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License Number State |
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