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General NPI Number Information
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NPI Number | 1871587527
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE COUNSELING SERVICES OF CERTIFIED SOCIAL WORKERS, PLLC
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 144 4TH AVENUE
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City | BAY SHORE
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State | NY
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Zip | 11706-7962
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Country | US
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Telephone | 631-665-6244
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Fax | 631-968-6169
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Provider Business Mailing Address
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Address Line | 144 4TH AVENUE
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City | BAY SHORE
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State | NY
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Zip | 11706-7962
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Country | US
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Telephone | 631-665-6244
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Fax | 631-968-6169
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Authorized Official
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Title or Position | OWNER/SOCIAL WORK THERAPIST
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Name | PETER THOMAS VIGLIOTTA
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Credential | LCSW
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Telephone | 631-665-6244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R046965-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R043922-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R040607-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NY
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