Shoreline Psychotherapy Crisis and Consultation Center LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SHORELINE PSYCHOTHERAPY CRISIS AND CONSULTATION CENTER LLC

Practice address

762 Boston Post Rd FL 2
Madison, CT 06443-3047

Phone

(203) 499-7890

NPI assigned

Jan 14, 2019

Last updated

Jan 14, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexander S Klein, LCSW

Title

Owner/LCSW

Phone

(203) 499-7890

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1427522358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 BOSTON POST RD FL 2",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433047",
            "telephone_number": "203-499-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 BOSTON POST RD FL 2",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064433047",
            "telephone_number": "203-499-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE PSYCHOTHERAPY CRISIS AND CONSULTATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-14",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/LCSW",
        "authorized_official_telephone_number": "203-499-7890",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shoreline Psychological
• Shoreline Speech Therapy
• Jessica Lyn Shultis
• Lillian Siegel, CNM
• Marisa Kelsey Sierra, LMFT
• Joseph M Slater, P.A.

• Clinical Social Worker in Madison, CT
• Providers in Madison, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; 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.