NPIMap

Organization Active NPI

South Shore Mental Health Counseling Services,PC

  • Professional Counselor
  • East Islip, NY
National Provider Identifier
1366890949
Registry record updated Apr 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
004685 Issued in NY
Legal business name
SOUTH SHORE MENTAL HEALTH COUNSELING SERVICES,PC
Practice address
200 Carleton Ave Ste D
East Islip, NY 11730-1222
Phone
(631) 579-3503
Fax
(631) 446-1136
NPI assigned
May 24, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2021

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

Authorized official

Name
Kenneth J RocheNPI 1578862728
Title
Director
Phone
(631) 235-4481

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
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 004685 NY Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

200 Carleton Ave Ste D
East Islip, NY 11730-1222

Mailing address

200 Carleton Ave Ste D
East Islip, NY 11730-1222
Phone (631) 579-3503

Other identifiers 1

IdentifierTypeStateIssuer
1578862728OtherNPI

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@southshoremhc.com

National Provider Directory

National Provider Directory

Locations

55 Carleton Ave
Ste 5
East Islip, NY 11730
Phone (631) 277-6673

200 Carleton Ave
Ste D
East Islip, NY 11730
Phone (631) 579-3503

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619308800000",
    "number": "1366890949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CARLETON AVE STE D",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117301222",
            "telephone_number": "631-579-3503",
            "fax_number": "631-446-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CARLETON AVE STE D",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117301222",
            "telephone_number": "631-579-3503",
            "fax_number": "631-446-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE MENTAL HEALTH COUNSELING SERVICES,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2021-04-25",
        "certification_date": "2021-04-25",
        "status": "A",
        "authorized_official_last_name": "ROCHE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "631-235-4481"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "NY",
            "license": "004685",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1578862728",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@southshoremhc.com",
            "affiliation": "N",
            "address_1": "200 Carleton Ave Ste D",
            "city": "East Islip",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117301222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Islip, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2021; 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.