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NPI Code Detail

MEDICARE: SOUTH SHORE COUNSELING AND ASSESSMENT

MEDICARE: SOUTH SHORE COUNSELING AND ASSESSMENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1699319822
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH SHORE COUNSELING AND ASSESSMENT
Provider Business Mailing Address
First Line : 82 CENTRE ST UNIT B
Second Line :
City : QUINCY
State : MA
Zip : 02169-6354
Country : US
Telephone Number : 781-974-2478
Fax Number :
Provider Business Practice Location Address
First Line : 1112 WASHINGTON ST STE 7
Second Line :
City : HANOVER
State : MA
Zip : 02339-1675
Country : US
Telephone Number : 781-353-9106
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KATHRYN KELLEY
Credential : LMHC
Telephone Number : 781-353-9106
Provider Enumeration Date : 10/31/2019
Last Update Date : 10/31/2019

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Directions to “SOUTH SHORE COUNSELING AND ASSESSMENT ” Practice Location

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