# LIFE SOURCE CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780795559
- **Authorized official:** MR. RAYMOND STEVEN SHOCKI MSW (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (860) 628-8474

## Contact information

- **Practice address:** 45 ARROWLEAF CT, CHESHIRE, CT 06410-3312
- **Practice address phone:** (860) 628-8474
- **Practice address fax:** (860) 621-0850
- **Mailing address:** 710 MAIN ST, BUILDING 3, SUITE 9, PLANTSVILLE, CT 06479-1565
- **Mailing address phone:** (860) 628-8474

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 000402 | CT | — |
| 106H00000X | Marriage & Family Therapist | 000320 | CT | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 09/11/2025