| Shoreline Psychiatry Of Western Connecticut, Llc | |
|
71 East Ave Suite V Norwalk CT 06851-4903 | |
| (203) 656-1452 | |
| (203) 656-1485 |
| Full Name | Shoreline Psychiatry Of Western Connecticut, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 71 East Ave, Norwalk, Connecticut |
| Authorized Official Name and Position | Barbara Stukes (OFFICE MANAGER) |
| Authorized Official Contact | 2036561452 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoreline Psychiatry Of Western Connecticut, Llc 71 East Ave Suite V Norwalk CT 06851-4903 Ph: (203) 656-1452 | Shoreline Psychiatry Of Western Connecticut, Llc 71 East Ave Suite V Norwalk CT 06851-4903 Ph: (203) 656-1452 |
| NPI Number | 1134251564 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 01/17/2013 |
| Medicare PECOS PAC ID | 9133228695 |
|---|---|
| Medicare Enrollment ID | O20070625000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134251564 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Camille A Weis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750345393 PECOS PAC ID: 0648266122 Enrollment ID: I20040421000789 |
| Provider Name | Jacqueline R Rugg |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1427077460 PECOS PAC ID: 1658374392 Enrollment ID: I20060817000534 |
| Provider Name | Bart A Sloan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447282371 PECOS PAC ID: 1850490319 Enrollment ID: I20070625000329 |
| Provider Name | Ruth M Grant |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891725925 PECOS PAC ID: 4880793371 Enrollment ID: I20070625000359 |
| Provider Name | Shira S Burstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184929580 PECOS PAC ID: 4688898711 Enrollment ID: I20170222001980 |
| Provider Name | Nina G Gerber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619415155 PECOS PAC ID: 4284918020 Enrollment ID: I20170223000495 |
| Provider Name | Lisa Marie Burton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073594479 PECOS PAC ID: 1850424367 Enrollment ID: I20190103003138 |
| Provider Name | Susan Mohr Daly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205418498 PECOS PAC ID: 0446657597 Enrollment ID: I20210916001859 |
| Provider Name | Ellen M Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467672097 PECOS PAC ID: 7113348632 Enrollment ID: I20221209001221 |
| Provider Name | Sara Khalid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730817636 PECOS PAC ID: 3274905864 Enrollment ID: I20230208000268 |
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