Organization
LIFE SOURCE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND STEVEN SHOCKI MSW (EXECUTIVE DIRECTOR)
(860) 628-8474
Entity
Organization
Contact information
Practice address
45 ARROWLEAF CT, CHESHIRE, CT 06410-3312
(860) 628-8474
(860) 621-0850
Mailing address
710 MAIN ST, BUILDING 3, SUITE 9, PLANTSVILLE, CT 06479-1565
(860) 628-8474
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
000402
CT
106H00000X
Marriage & Family Therapist
Primary
000320
CT
Other
Enumeration date
08/31/2006
Last updated
09/11/2025
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