Provider Demographics
NPI:1144559881
Name:SOUTH SHORE PSYCHOLOGICAL CARE P.C.
Entity type:Organization
Organization Name:SOUTH SHORE PSYCHOLOGICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:D'ELENA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-786-8930
Mailing Address - Street 1:250 MONTAUK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940
Mailing Address - Country:US
Mailing Address - Phone:631-786-8930
Mailing Address - Fax:631-874-2824
Practice Address - Street 1:250 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940
Practice Address - Country:US
Practice Address - Phone:631-786-8930
Practice Address - Fax:631-874-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty