NPIMap

Organization Active NPI

South Shore Counseling and Psychological Services P C

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wantagh, NY
National Provider Identifier
1336209469
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
0124781 Issued in NY
Legal business name
SOUTH SHORE COUNSELING AND PSYCHOLOGICAL SERVICES P C
Practice address
3305 Jerusalem Ave Ste 207
Wantagh, NY 11793-2028
Phone
(516) 785-0323
Fax
(516) 785-6026
NPI assigned
Dec 11, 2006
Last updated
Aug 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Authorized official

Name
William James, PHDNPI 1346364163
Title
Owner
Phone
(516) 785-0323

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0124781 NY Primary

Addresses

Primary practice location

3305 Jerusalem Ave Ste 207
Wantagh, NY 11793-2028

Mailing address

3305 Jerusalem Ave Ste 207
Wantagh, NY 11793-2028
Phone (516) 785-0323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090818000053 NY Part B Supplier - Clinic/Group Practice 5890849434 Receives reassigned benefits from 12 practitioners
Practice locations: Wantagh, NY

National Provider Directory

National Provider Directory

Locations

217 Merrick Rd
Ste 212
Amityville, NY 11701

1051 Wantagh Ave
Wantagh, NY 11793
Phone (516) 551-9739

3305 Jerusalem Ave
Wantagh, NY 11793
Phone (516) 785-0323

3305 Jerusalem Ave
Ste 207
Wantagh, NY 11793
Phone (516) 320-3999

20 Crossways Park Dr N
Ste 400
Woodbury, NY 11797
Phone (516) 387-6972

Practitioners & affiliated clinicians

Practitioners 38

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.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1336209469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 JERUSALEM AVE STE 207",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932028",
            "telephone_number": "516-785-0323",
            "fax_number": "516-785-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 JERUSALEM AVE STE 207",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117932028",
            "telephone_number": "516-785-0323",
            "fax_number": "516-785-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE COUNSELING AND PSYCHOLOGICAL SERVICES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-785-0323",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NY",
            "license": "0124781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wantagh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.