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Organization
SOUTHSHORE COUNSELING MEDIATION AND LICENSED CLINICAL SOCIAL WORK SERV
Active
Organization
SOUTHSHORE COUNSELING MEDIATION AND LICENSED CLINICAL SOCIAL WORK SERV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE CAVALERI LCSW (EXECUTIVE OFFICER)
(631) 286-8282
Entity
Organization
Contact information
Practice address
36 EDGAR AVE, BROOKHAVEN, NY 11719-9655
(631) 286-8282
(631) 803-6793
Mailing address
36 EDGAR AVE, BROOKHAVEN, NY 11719-9655
(631) 286-8282
(631) 803-6793
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
075548-1
NY
Other
Enumeration date
03/26/2009
Last updated
04/15/2016
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