| Organization Name: | SOUTH SHORE MENTAL HEALTH COUNSELING SERVICES,PC |
| NPI Number: | 1366890949 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH ROCHE (DIRECTOR) |
| Mailing Address: | 55 Carleton Ave Suite 5 East Islip |
| State: | NY US |
| Postal Code: | 117302133 |
| Phone Number: | 6315793503 |
| Fax Number: | 6314461136 |
| NPI Enumeration Date: | 05/24/2016 |
| NPI Last Update Date: | 05/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 004685 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |