Provider Demographics
NPI:1205972601
Name:SOUTH SHORE CHILD ASSOCIATION INCORPORATED
Entity type:Organization
Organization Name:SOUTH SHORE CHILD ASSOCIATION INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGEMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-739-7733
Mailing Address - Street 1:114 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3731
Mailing Address - Country:US
Mailing Address - Phone:516-868-3030
Mailing Address - Fax:516-868-3374
Practice Address - Street 1:114 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3731
Practice Address - Country:US
Practice Address - Phone:516-868-3030
Practice Address - Fax:516-868-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080310993251S00000X
NY160310993251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00336943Medicaid
NY080310993OtherOASAS OPERATING CERTIFICA
NY03001127Medicaid