SHORELINE NEUROPSYCHIATRIC SERVICES, LLC (NPI# 1124569157) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124569157 |
| Entity Type | Organization |
| Organization Name | SHORELINE NEUROPSYCHIATRIC SERVICES, LLC |
| Practice Address |
215 Broad St Unit 2w Milford CT 06460-4760 |
| Practice Telephone | 2037279583 |
| Practice Fax Number | 2033819477 |
| Mailing Telephone | 2037279583 |
| Mailing Fax Number | 2033819477 |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2017-03-09 |
| Authorized Official Name | MR. BRUCE JAMIE STEVENS (MANAGING MEMBER) |
| Authorized Official Telephone | 2037279583 |
| Authorized Official Credential | PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
12.004567 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | SHORELINE NEUROPSYCHIATRIC SERVICES, LLC | 215 North Broad Street, 2w, Milford, CT 06460 |
| Street Address |
215 BROAD ST UNIT 2W |
| City | MILFORD |
| State | CT |
| Zip Code | 06460-4760 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114220613 | Bruce Jamie Stevens | Nurse Practitioner | 215 Broad St, Apt 2w, Milford, CT 06460-4760 | 2010-12-06 |
| 1669525077 | Lynn K. Persson | Counselor | 215 Broad St, Milford, CT 06460-4760 | 2007-01-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326678616 | Tracy Southworth | Social Worker | 4 Oxford Road, Suite B-6, Milford Ct, CT 06460 | 2020-01-25 |
| 1598301707 | Mahboob Ur Rehman | Pharmacist | 1082 Boston Post Road, Milford, CT 06460 | 2019-11-22 |
| 1750800223 | Caitlin E Kingston | Counselor | 48 Argyle Rd, Milford, CT 06460 | 2017-09-15 |
| 1912437609 | Vanessa Elizabeth Kellas | Counselor | 949 Bridgport Ave, Milford, CT 06460 | 2017-06-14 |
| 1548634454 | Rian Degroat | Case Manager/Care Coordinator | 949-941 Bridgeport Ave, Milford, CT 06460 | 2015-11-17 |
| 1619354446 | Stephanie Meoli | Occupational Therapist | 195 Platt Street, Milford, CT 06460 | 2015-04-30 |
| 1588069298 | Elizabeth Laliberte | Counselor | 37 Bridgeport Ave, 2nd Floor, Milford, CT 06460 | 2014-10-24 |
| 1366869851 | Chamonix Sikora | Speech-Language Pathologist | 8b Church Street South, Westport, CT 06460 | 2014-03-24 |
| 1528404688 | Alexandra Garces | Nutritionist | 150 New Haven Avenue, Milford, CT 06460 | 2013-05-16 |
| 1598100869 | Seabright Cardiovascular Center, LLC | Internal Medicine | 353 Bridgeport Ave, Milford, CT 06460 | 2013-05-01 |
| Find all providers in zip 06460 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679032163 | Angela Michelle Wagner | Nurse Practitioner | 1077 State Route 28 Ste 202, Milford, OH 45150-4000 | 2019-03-14 |
| 1972867695 | Susan J Boorin | Nurse Practitioner | 120 Broad St, Milford, CT 06460-4725 | 2012-06-27 |
| 1124301023 | Roxann Jean Hackbarth | Nurse Practitioner | 1004 21st St, Suite #3, Milford, IA 51351-7421 | 2011-09-27 |
| 1083748214 | Patrick Lynn Gagnon | Nurse Practitioner | 80 E Broadway Apt D, Milford, CT 06460-6120 | 2007-03-16 |
| 1023195765 | Christine S Simpson | Nurse Practitioner | 45 Wildemere Ave, Milford, CT 06460-5354 | 2006-11-01 |
| 1427168111 | Ruth Sposili | Nurse Practitioner | 11 Norman Cir, Milford, CT 06460-4234 | 2006-08-30 |
| 1245256692 | Laura Giesman | Nurse Practitioner | 52 W Main St, Suite 905, Milford, CT 06460-3310 | 2006-07-15 |
| 1336664598 | Anthony Michael Trezza | Nurse Practitioner | 949 Bridgeport Ave, Milford, CT 06460-3142 | 2017-08-09 |
| 1609391978 | Desiree Marie Thomas | Nurse Practitioner | 247 Broad St, Milford, CT 06460-3273 | 2017-08-08 |
| 1821542408 | Fresh Pathways | Nurse Practitioner | 57 Plains Rd, Milford, CT 06461-2573 | 2016-08-11 |
| Find all providers in MILFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.