Provider Demographics
NPI:1215671326
Name:SSCN LLC
Entity type:Organization
Organization Name:SSCN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-261-6285
Mailing Address - Street 1:2575 NORTHBROOKE PLAZA DR UNIT 206
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8099
Mailing Address - Country:US
Mailing Address - Phone:815-261-6285
Mailing Address - Fax:
Practice Address - Street 1:2575 NORTHBROOKE PLAZA DR UNIT 206
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8099
Practice Address - Country:US
Practice Address - Phone:815-261-6285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty