NPIMap

Organization Active NPI

Shoreline Center for Family Counseling & Psychotherapy, LLC

  • Clinical Social Worker
  • Branford, CT
National Provider Identifier
1225354988
Registry record updated Oct 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
006202 Issued in CT
Legal business name
SHORELINE CENTER FOR FAMILY COUNSELING & PSYCHOTHERAPY, LLC
Practice address
9 Business Park Dr
Branford, CT 06405-2931
Phone
(203) 433-0299
Fax
(203) 643-2042
NPI assigned
Apr 20, 2010
Last updated
Oct 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2014

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

Authorized official

Name
David Ewing, LCSW
Title
Owner
Phone
(203) 433-0299

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 006202 CT Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X 005763 CT

Addresses

Primary practice location

9 Business Park Dr
Branford, CT 06405-2931

Mailing address

9 Business Park Dr
Branford, CT 06405-2931
Phone (203) 433-0299

National Provider Directory

National Provider Directory

Locations

173 Montowese St
Branford, CT 06405
Phone (203) 433-0299

9 Business Park Dr
Branford, CT 06405
Phone (203) 433-0299

9 Business Park Dr
Ste 1
Branford, CT 06405
Phone (203) 433-0299

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414540800000",
    "number": "1225354988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 BUSINESS PARK DR",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064052931",
            "telephone_number": "203-433-0299",
            "fax_number": "203-643-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 BUSINESS PARK DR",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064052931",
            "telephone_number": "203-433-0299",
            "fax_number": "203-643-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE CENTER FOR FAMILY COUNSELING & PSYCHOTHERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2014-10-29",
        "status": "A",
        "authorized_official_last_name": "EWING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-433-0299",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006202",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "005763",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Branford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; 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.