Provider Demographics
NPI:1184021503
Name:NORTH SHORE ADDICTION AND MENTAL HEALTH COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:NORTH SHORE ADDICTION AND MENTAL HEALTH COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN-KRUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CASAC
Authorized Official - Phone:631-780-5752
Mailing Address - Street 1:21 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-321-1005
Practice Address - Street 1:21 REDWOOD LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2718
Practice Address - Country:US
Practice Address - Phone:631-780-5752
Practice Address - Fax:631-321-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty