Provider Demographics
NPI: | 1023187366 |
---|---|
Name: | NORTH SHORE COUNSELING CENTER INC |
Entity Type: | Organization |
Organization Name: | NORTH SHORE COUNSELING CENTER INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SAMUEL |
Authorized Official - Middle Name: | MARK |
Authorized Official - Last Name: | MIGDOLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | EDD |
Authorized Official - Phone: | 978-922-2280 |
Mailing Address - Street 1: | 23 BROADWAY |
Mailing Address - Street 2: | |
Mailing Address - City: | BEVERLY |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01915-4417 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 978-922-2280 |
Mailing Address - Fax: | 978-927-1758 |
Practice Address - Street 1: | 23 BROADWAY |
Practice Address - Street 2: | |
Practice Address - City: | BEVERLY |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01915-4417 |
Practice Address - Country: | US |
Practice Address - Phone: | 978-922-2280 |
Practice Address - Fax: | 978-927-1758 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-08 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 101YA0400X, 101YM0800X, 103T00000X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 104100000X, 1041C0700X | ||
MA | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
Not Answered | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
Not Answered | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
Not Answered | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
Not Answered | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
Not Answered | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
Not Answered | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
Not Answered | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
Not Answered | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
Not Answered | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
Not Answered | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
Not Answered | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
Not Answered | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 1010630 | Other | BEACON HEALTH |
MA | 97964101 | Other | NETWORK HEALTH |
MA | M12435 | Other | BLUE CROSS |
MA | W10026 | Other | BLUE CROSS |
MA | 901877 | Other | TUFTS |
MA | 1302892 | Medicaid | |
MA | W10026 | Other | BLUE CROSS |
MA | M12435 | Medicare ID - Type Unspecified |