| Life Source Center, Inc | |
|
45 Arrowleaf Ct Cheshire CT 06410-3312 | |
| (860) 628-8474 | |
| (860) 621-0850 |
| Full Name | Life Source Center, Inc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 45 Arrowleaf Ct, Cheshire, Connecticut |
| Authorized Official Name and Position | Raymond Steven Shocki (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8606288474 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Source Center, Inc 710 Main St Building 3, Suite 9 Plantsville CT 06479-1565 Ph: (860) 628-8474 | Life Source Center, Inc 45 Arrowleaf Ct Cheshire CT 06410-3312 Ph: (860) 628-8474 |
| NPI Number | 1780795559 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4082612957 |
|---|---|
| Medicare Enrollment ID | O20061201000431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780795559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 000402 (Connecticut) | Primary |
| 106H00000X | Marriage & Family Therapist | 000320 (Connecticut) | Primary |
| Provider Name | Raymond S Shocki |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245305135 PECOS PAC ID: 3274531140 Enrollment ID: I20061201000414 |
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