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SOUTHERN CT CHRISTIAN NETWORK NPI 1033239249


NPI Information

NPI: 1033239249
Provider Name: SOUTHERN CT CHRISTIAN NETWORK

Doing Business As: SHORELINE CHRISTIAN COUNSELING

Classification: Psychiatry & Neurology - 2084F0202X
Entity Type: Organization

Specialization: Forensic Psychiatry

Address:
145 DURHAM RD
MAILBOX 7
MADISON, CT
ZIP 06443
Phone: (203) 318-0070
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SOUTHERN CT CHRISTIAN NETWORK is a forensic psychiatry psychiatry neurology in Madison, CT. The provider is forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals. SOUTHERN CT CHRISTIAN NETWORK NPI is 1033239249. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shoreline Christian Counseling.

The provider's business location address is:

145 DURHAM RD
MAILBOX 7
MADISON, CT
ZIP 06443-674
Phone: (203) 318-0070
Fax: (206) 339-8205

The provider's authorized official is Ulari Dike .
The authorized official title is Office Manager and has the following contact phone number (203) 318-0700.

The enumeration date for this NPI number is 3/30/2007 and was last updated on 10/14/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC0700XPsychologistClinical001460CONNECTICUTNo
21041C0700XSocial WorkerClinical002876CONNECTICUTNo
31041C0700XSocial WorkerClinical004809CONNECTICUTNo
42084F0202XPsychiatry & NeurologyForensic Psychiatry039301CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1004257269MEDICAIDCONNECTICUT
2004257532MEDICAIDCONNECTICUT
3307875OTHERCONNECTICUTHEALTHNET-MHN
4004257277MEDICAIDCONNECTICUT
5C02421MEDICARE PINCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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