Provider Demographics
NPI:1558697573
Name:SOUTH SHORE CENTER FOR WELLNESS LTD
Entity Type:Organization
Organization Name:SOUTH SHORE CENTER FOR WELLNESS LTD
Other - Org Name:SOUTH SHORE COUNSELING & SPEECH PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-878-8340
Mailing Address - Street 1:222 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1262
Mailing Address - Country:US
Mailing Address - Phone:781-878-8340
Mailing Address - Fax:
Practice Address - Street 1:222 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1262
Practice Address - Country:US
Practice Address - Phone:781-878-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty