Basic Information
| Provider Information | |||||||||
| NPI: | 1326376195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH BAY MENTAL HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 BELMONT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023015299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085804691 | ||||||||
| FaxNumber: | 5085885751 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 ALDRIN RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023604827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088300004 | ||||||||
| FaxNumber: | 5088300295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2009 | ||||||||
| LastUpdateDate: | 12/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | WOODS | ||||||||
| AuthorizedOfficialFirstName: | FRANCIS | ||||||||
| AuthorizedOfficialMiddleName: | BERNARD | ||||||||
| AuthorizedOfficialTitleorPosition: | TREATMENT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5088300004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.