Organization
SOUTH SHORE MENTAL HEALTH COUNSELING SERVICES,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH J ROCHE (DIRECTOR)
(631) 235-4481
Entity
Organization
Contact information
Practice address
200 CARLETON AVE STE D, EAST ISLIP, NY 11730-1222
(631) 579-3503
(631) 446-1136
Mailing address
200 CARLETON AVE STE D, EAST ISLIP, NY 11730-1222
(631) 579-3503
(631) 446-1136
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
004685
NY
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578862728
NPI
—
Enumeration date
05/24/2016
Last updated
04/25/2021
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