Basic Information
| Provider Information | |||||||||
| NPI: | 1134207657 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH SHORE MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 96 OLD COLONY AVE APT 317 | ||||||||
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| City: | EAST TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027181127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084463963 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8 HANCOCK CT | ||||||||
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| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021695210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178471950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MANNING | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | ERIN | ||||||||
| AuthorizedOfficialTitleorPosition: | M.S.W. INTERN | ||||||||
| AuthorizedOfficialTelephone: | 5084463963 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.