| South Shore Child Association Incorporated | |
|
114 Church Street Freeport NY 11520-3731 | |
| (516) 868-3030 | |
| (516) 868-3374 |
| Full Name | South Shore Child Association Incorporated |
|---|---|
| Speciality | Case Management |
| Location | 114 Church Street, Freeport, New York |
| Authorized Official Name and Position | Natalie M Richman (REVENUE MANAGEMENT ADMINISTRATOR) |
| Authorized Official Contact | 5167397733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Shore Child Association Incorporated 114 Church Street Freeport NY 11520-3731 Ph: (516) 868-3030 | South Shore Child Association Incorporated 114 Church Street Freeport NY 11520-3731 Ph: (516) 868-3030 |
| NPI Number | 1205972601 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 06/19/2023 |
| Certification Date | 06/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205972601 | NPI | - | NPPES |
| 00336943 | Medicaid | NY | |
| 080310993 | Other | NY | OASAS OPERATING CERTIFICA |
| 03001127 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 080310993 (New York) | Secondary |
| 251B00000X | Case Management | 160310993 (New York) | Primary |
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