NPIMap

Organization Active NPI

Shoreham Psychotherapy Services LCSW PLLC

  • Clinical Social Worker
  • Shoreham, NY
National Provider Identifier
1669860573
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R022772 Issued in NY
Legal business name
SHOREHAM PSYCHOTHERAPY SERVICES LCSW PLLC
Practice address
45 Route 25a
Suite A2
Shoreham, NY 11786-1389
Phone
(631) 821-5056
Fax
(631) 821-5056
NPI assigned
Dec 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Authorized official

Name
Mary Lee Hasbrouck, LCSWNPI 1457463598
Title
President
Phone
(631) 821-5056

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
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X R022772 NY Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 117957 MA

Addresses

Primary practice location

45 Route 25a
Suite A2
Shoreham, NY 11786-1389

Mailing address

45 Route 25a
Suite A2
Shoreham, NY 11786-1389
Phone (631) 821-5056

Other identifiers 2

IdentifierTypeStateIssuer
01475396MedicaidNY
10498656OtherNYCAQH

National Provider Directory

National Provider Directory

Locations

45 Route 25A
Ste A2
Shoreham, NY 11786
Phone (631) 821-1880

Practitioners & affiliated clinicians

Practitioners 1

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": "1419897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1669860573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 ROUTE 25A",
            "address_2": "SUITE A2",
            "city": "SHOREHAM",
            "state": "NY",
            "postal_code": "117861389",
            "telephone_number": "631-821-5056",
            "fax_number": "631-821-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 ROUTE 25A",
            "address_2": "SUITE A2",
            "city": "SHOREHAM",
            "state": "NY",
            "postal_code": "117861389",
            "telephone_number": "631-821-5056",
            "fax_number": "631-821-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOREHAM PSYCHOTHERAPY SERVICES LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-30",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "HASBROUCK",
        "authorized_official_first_name": "MARY LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-821-5056",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R022772",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "117957",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01475396",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10498656",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.