| Southshore Counseling Mediation And Licensed Clinical Social Work Serv | |
|
36 Edgar Ave Brookhaven NY 11719-9655 | |
| (631) 286-8282 | |
| (631) 803-6793 |
| Full Name | Southshore Counseling Mediation And Licensed Clinical Social Work Serv |
|---|---|
| Speciality | Social Worker |
| Location | 36 Edgar Ave, Brookhaven, New York |
| Authorized Official Name and Position | Michelle Cavaleri (EXECUTIVE OFFICER) |
| Authorized Official Contact | 6312868282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southshore Counseling Mediation And Licensed Clinical Social Work Serv 36 Edgar Ave Brookhaven NY 11719-9655 Ph: (631) 286-8282 | Southshore Counseling Mediation And Licensed Clinical Social Work Serv 36 Edgar Ave Brookhaven NY 11719-9655 Ph: (631) 286-8282 |
| NPI Number | 1366684078 |
|---|---|
| Provider Enumeration Date | 03/26/2009 |
| Last Update Date | 04/15/2016 |
| Medicare PECOS PAC ID | 1951468305 |
|---|---|
| Medicare Enrollment ID | O20090330000436 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366684078 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 075548-1 (New York) | Primary |
| Provider Name | Michelle Cavaleri |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295885051 PECOS PAC ID: 6103929732 Enrollment ID: I20070320000045 |
| Provider Name | Jose Vargas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174727440 PECOS PAC ID: 5799935649 Enrollment ID: I20121030000479 |
| Provider Name | Jay A Hart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225466550 PECOS PAC ID: 5092939918 Enrollment ID: I20140617000322 |
| Provider Name | Marcia Mccarroll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710215066 PECOS PAC ID: 3274841416 Enrollment ID: I20151007002419 |