Provider Demographics
NPI:1215378674
Name:SOUTH SHORE CHILD AND FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:SOUTH SHORE CHILD AND FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUJUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:857-499-0259
Mailing Address - Street 1:639 GRANITE ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5366
Mailing Address - Country:US
Mailing Address - Phone:857-499-0259
Mailing Address - Fax:
Practice Address - Street 1:639 GRANITE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5366
Practice Address - Country:US
Practice Address - Phone:857-499-0259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty