NPIMap

Organization Active NPI

Shoreline Psychological

  • Clinical Psychologist
  • Madison, CT
National Provider Identifier
1750927802
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SHORELINE PSYCHOLOGICAL
Practice address
17A Woodland Rd
Madison, CT 06443-2342
Phone
(203) 779-5490
Fax
(203) 896-9830
NPI assigned
Nov 25, 2019
Last updated
Sep 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Authorized official

Name
Dr. Abby Lipschutz, PSY.D.NPI 1144347287
Title
Director/Owner
Phone
(646) 265-2850

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
Clinical Psychologist 103TC0700X NU Primary

Addresses

Primary practice location

17A Woodland Rd
Madison, CT 06443-2342

Mailing address

17A Woodland Rd
Madison, CT 06443-2342
Phone (203) 779-5490

Other names 1

  • Shoreline Psychological Former legal business name

National Provider Directory

National Provider Directory

Locations

17A Woodland Rd
Madison, CT 06443
Phone (203) 779-5490

Practitioners & affiliated clinicians

Practitioners 3

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": "1574640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1750927802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17A WOODLAND RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432342",
            "telephone_number": "203-779-5490",
            "fax_number": "203-896-9830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17A WOODLAND RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432342",
            "telephone_number": "203-779-5490",
            "fax_number": "203-896-9830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE PSYCHOLOGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-25",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A",
        "authorized_official_last_name": "LIPSCHUTZ",
        "authorized_official_first_name": "ABBY",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "646-265-2850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoreline Psychological",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Madison, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.