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SOUTH SHORE COLLABORATIVE PSYCHIATRY NP, PLLC

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Company Details

Name: SOUTH SHORE COLLABORATIVE PSYCHIATRY NP, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 05 Dec 2017 (8 years ago)
Entity Number: 5244868
ZIP code: 11751
County: Suffolk
Place of Formation: New York
Address: 74 BEAVERDAM ROAD, ISLIP, NY, United States, 11751

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 74 BEAVERDAM ROAD, ISLIP, NY, United States, 11751

National Provider Identifier

NPI Number:
1942882246
Certification Date:
2021-04-26

Authorized Person:

Name:
SAMANTHA ROCHE
Role:
PMHNP-BC
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
6312776039

Filings

Filing Number Date Filed Type Effective Date
180228000268 2018-02-28 CERTIFICATE OF PUBLICATION 2018-02-28
171205000003 2017-12-05 ARTICLES OF ORGANIZATION 2017-12-05

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Date of last update: 24 Mar 2025

Sources: New York Secretary of State