Provider Demographics
NPI:1235229030
Name:SOUTHSHORE COUPLES & FAMILY COUNSELING CENTER
Entity Type:Organization
Organization Name:SOUTHSHORE COUPLES & FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:516-431-3130
Mailing Address - Street 1:143 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3522
Mailing Address - Country:US
Mailing Address - Phone:516-431-3130
Mailing Address - Fax:516-431-3130
Practice Address - Street 1:143 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3522
Practice Address - Country:US
Practice Address - Phone:516-431-3130
Practice Address - Fax:516-431-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty