| Shoreline Wellness Behavioral Health Outreach Inc | |
|
415 Main Street West Haven CT 06516 | |
| (203) 931-1184 | |
| (203) 931-0063 |
| Full Name | Shoreline Wellness Behavioral Health Outreach Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 415 Main Street, West Haven, Connecticut |
| Authorized Official Name and Position | Cara M Powers (FOUNDER & PRESIDENT) |
| Authorized Official Contact | 2039311184 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoreline Wellness Behavioral Health Outreach Inc 415 Main Street West Haven CT 06516 Ph: (203) 931-1184 | Shoreline Wellness Behavioral Health Outreach Inc 415 Main Street West Haven CT 06516 Ph: (203) 931-1184 |
| NPI Number | 1144723305 |
|---|---|
| Provider Enumeration Date | 03/14/2018 |
| Last Update Date | 03/14/2018 |
| Medicare PECOS PAC ID | 1951796119 |
|---|---|
| Medicare Enrollment ID | O20220325000121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144723305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Lori Skevas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437421765 PECOS PAC ID: 4981863396 Enrollment ID: I20120305000211 |
| Provider Name | Kaydian N Harrison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073823498 PECOS PAC ID: 2466775325 Enrollment ID: I20141229000938 |
| Provider Name | Samya Hawley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336351048 PECOS PAC ID: 0042515538 Enrollment ID: I20160222000806 |
| Provider Name | Michael G. Suraci |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629436258 PECOS PAC ID: 4981988623 Enrollment ID: I20170224002029 |
| Provider Name | Louis Damora |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477079499 PECOS PAC ID: 9133495294 Enrollment ID: I20171018000991 |
| Provider Name | Brandi Lynn Krassler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558034363 PECOS PAC ID: 4981000817 Enrollment ID: I20210901001461 |
| Provider Name | Stephanie Encarnacion |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861167611 PECOS PAC ID: 6800293564 Enrollment ID: I20210922001751 |
| Provider Name | Lisa Spearman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114695350 PECOS PAC ID: 5092103325 Enrollment ID: I20211019002057 |
| Provider Name | Jenna Sheppard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437826252 PECOS PAC ID: 5496147217 Enrollment ID: I20220127002072 |
| Provider Name | Sarah Nicole Moran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033804141 PECOS PAC ID: 8820455801 Enrollment ID: I20230606003517 |
| Provider Name | Lindsay Rose Rhys |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295464519 PECOS PAC ID: 7012378185 Enrollment ID: I20230804003341 |
| Provider Name | Sharnelle Branyon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760928519 PECOS PAC ID: 9931545639 Enrollment ID: I20240315000962 |
| Provider Name | Jordan Baronski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982245486 PECOS PAC ID: 1456797166 Enrollment ID: I20240315001123 |
| Provider Name | Emajae Ricketts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730739293 PECOS PAC ID: 5395181002 Enrollment ID: I20240315001392 |
| Provider Name | Nicole Wetmore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639449499 PECOS PAC ID: 0547606295 Enrollment ID: I20240315002730 |
| Provider Name | Kaitlyn Bruneau |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447033717 PECOS PAC ID: 9830535590 Enrollment ID: I20240315003099 |
| Provider Name | Cara Powers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952433591 PECOS PAC ID: 9032369194 Enrollment ID: I20240316000075 |
| Provider Name | Soulyma Lahnin-yaghzar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427243690 PECOS PAC ID: 2365889276 Enrollment ID: I20240327000231 |
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