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General NPI Number Information
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NPI Number | 1902529399
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Entity Type | Organization
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Legal Business Name | SHORELINE PSYCHOTHERAPY
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 35 ATLANTIC AVE
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City | MANASQUAN
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State | NJ
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Zip | 08736-2901
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Country | US
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Telephone | 631-241-8054
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Fax |
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Provider Business Mailing Address
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Address Line | 175 W COHAWKIN RD STE C
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City | CLARKSBORO
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State | NJ
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Zip | 08020-1145
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Country | US
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Telephone | 856-423-7700
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Fax | 856-423-0823
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JESSICA CAVAN
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Credential | LCSW
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Telephone | 631-241-8054
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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 |
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License Number State |
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