Basic Information
| Provider Information | |||||||||
| NPI: | 1275971368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH BAY MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 BEECHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605408 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 W CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023017501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085804691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2013 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | SILVA | ||||||||
| AuthorizedOfficialFirstName: | NERRISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BEHAVIOR MANAGEMENT MONITOR | ||||||||
| AuthorizedOfficialTelephone: | 4014408987 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTH BAY MENTAL HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.