NPIMap

Organization Active NPI

Shoreline Neuropsychiatric Services, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Guilford, CT
National Provider Identifier
1124569157
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
12.004567 Issued in CT
Legal business name
SHORELINE NEUROPSYCHIATRIC SERVICES, LLC
Practice address
99 Whitfield St
Guilford, CT 06437-3429
Phone
(203) 244-3443
Fax
(860) 261-0669
NPI assigned
Mar 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bruce Jamie Stevens, PMHNPNPI 1114220613
Title
Owner
Phone
(203) 693-1510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X 12.004567 CT Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X

Addresses

Primary practice location

99 Whitfield St
Guilford, CT 06437-3429

Mailing address

6209 Knightsgate CT
Charlotte, NC 28269-0603
Phone (203) 693-1510

Other practice location 1

3013 Dixwell Ave
Hamden, CT 06518-3527
Phone (475) 244-3443

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1124569157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6209 KNIGHTSGATE CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282690603",
            "telephone_number": "203-693-1510",
            "fax_number": "938-253-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 WHITFIELD ST",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064373429",
            "telephone_number": "203-244-3443",
            "fax_number": "860-261-0669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3013 Dixwell Ave",
            "address_purpose": "LOCATION",
            "city": "Hamden",
            "state": "CT",
            "postal_code": "065183527",
            "country_code": "US",
            "telephone_number": "475-244-3443",
            "fax_number": "860-261-0669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHORELINE NEUROPSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-09",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "JAMIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-693-1510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "12.004567",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Guilford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.