Provider Demographics
NPI:1972973071
Name:SHORELINE SOCIAL LEARNING
Entity Type:Organization
Organization Name:SHORELINE SOCIAL LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOULGARAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:203-451-0549
Mailing Address - Street 1:377 MAIN ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:377 MAIN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4311
Practice Address - Country:US
Practice Address - Phone:203-693-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty