SOUTH BAY MENTAL HEALTH CENTER, INC. (NPI# 1023096864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023096864 |
| Entity Type | Organization |
| Organization Name | SOUTH BAY MENTAL HEALTH CENTER, INC. |
| Other Organization Name | SOUTH BAY COMMUNITY SERVICES |
| Practice Address |
1115 West Chestnut Street Suite 202 Brockton MA 02301 |
| Practice Telephone | 5085212200 |
| Practice Fax Number | 5085842227 |
| Mailing Telephone | 5085212200 |
| Mailing Fax Number | 5085842227 |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2019-04-01 |
| Authorized Official Name | SARA J HART (PRESIDENT/COO) |
| Authorized Official Telephone | 5083240328 |
| Authorized Official Credential | LMHC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
4222 | MA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 1300423 | 05 | |
| MA | 1309056 | 05 | |
| MA | 1309196 | 05 | |
| MA | 1311964 | 05 | |
| MA | 1309137 | 05 | |
| MA | 1310003 | 05 | |
| MA | 1311093 | 05 | |
| MA | 1312065 | 05 | |
| MA | 1319779 | 05 | |
| MA | 1309218 | 05 | |
| MA | 1309226 | 05 | |
| MA | 1312472 | 05 | |
| MA | 1309994 | 05 | |
| MA | 1310976 | 05 | |
| MA | 1316478 | 05 |
| Other Name | Type Code |
|---|---|
| South Bay Community Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033294558 | South Bay Mental Health Center, Inc. | Clinic/Center | 1115 West Chestnut Street Suite 202, Brockton, MA 02301 | 2006-10-25 |
| 1750703062 | South Bay Mental Health Center, Inc. | Early Intervention Provider Agency | 1115 West Chestnut Street, Suite 202, Brockton, MA 02301 | 2014-01-07 |
| 1326376195 | South Bay Mental Health Center, Inc. | Community/Behavioral Health | 50 Aldrin Rd, Plymouth, MA 02360-4827 | 2009-12-05 |
| 1760560650 | South Bay Mental Health Center, Inc. | Clinic/Center | 37 Belmont St, Brockton, MA 02301-5299 | 2006-11-01 |
| 1679651566 | South Bay Mental Health Center, Inc. | Clinic/Center | 37 Belmont St, Brockton, MA 02301-5299 | 2006-11-01 |
| 1568540458 | South Bay Mental Health Center, Inc. | Clinic/Center | 37 Belmont St, Brockton, MA 02301-5299 | 2006-11-01 |
| 1477631364 | South Bay Mental Health Center, Inc. | Clinic/Center | 37 Belmont St, Brockton, MA 02301-5299 | 2006-11-01 |
| 1497830905 | South Bay Mental Health Center, Inc. | Clinic/Center | 37 Belmont St, Brockton, MA 02301-5299 | 2006-10-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | SOUTH BAY MENTAL HEALTH CENTER, INC. | 1115 West Chestnut Street, Brockton, MA 02301 |
| Connecticut Business Registrations | SOUTH BAY MENTAL HEALTH CENTER, INC. | 1115 West Chestnut St, Brockton, MA 02301 |
| Street Address |
1115 WEST CHESTNUT STREET SUITE 202 |
| City | BROCKTON |
| State | MA |
| Zip Code | 02301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629440813 | Sara M Ryan | Student in an Organized Health Care Education/Training Program | 1115 West Chestnut Street, South Bay Mental Health, Brockton, MA 02301 | 2015-10-27 |
| 1063837540 | Jessica Connearney | Social Worker | 1115 West Chestnut Street, Brockton, MA 02301 | 2014-02-20 |
| 1750703062 | South Bay Mental Health Center, Inc. | Early Intervention Provider Agency | 1115 West Chestnut Street, Suite 202, Brockton, MA 02301 | 2014-01-07 |
| 1225478498 | Barbara Ann Cleary-simons | Behavioral Analyst | 1115 West Chestnut Street, South Bay Mental Health, Brockton, MA 02301 | 2013-07-02 |
| 1083964423 | Alicia King | Counselor | 1115 West Chestnut Street, Brockton, MA 02301 | 2012-09-13 |
| 1609125079 | Talitha Anne Collins | Counselor | 1115 West Chestnut Street, Brockton, MA 02301 | 2012-08-31 |
| 1538417118 | Ann Mary Grell | Counselor | 1115 West Chestnut Street, Brockton, MA 02301 | 2012-08-29 |
| 1437424397 | Juli Ann Sullivan | Student in an Organized Health Care Education/Training Program | 1115 West Chestnut Street, Brockton, MA 02301 | 2012-03-12 |
| 1205104064 | Alex J Weinstock | Counselor | 1115 West Chestnut Street, Brockton, NY 02301 | 2011-12-08 |
| 1164707030 | Nicole Diasio Burk | Counselor | 1115 West Chestnut Street, Brockton, MA 02301 | 2011-10-11 |
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| 1124530373 | Rachel Theys | Behavioral Analyst | 130 Liberty St Ste 13a, Brockton, MA 02301 | 2017-10-27 |
| 1689193369 | Anderson D Delgado | Behavior Technician | 11 Packard Way, Brockton, MA 02301 | 2017-09-14 |
| 1811415326 | Francesca Lavecchia | Clinical Neuropsychologist | Brockto Area Multi Service, Inc. 10 Christy Dr., Brockton, MA 02301 | 2017-09-05 |
| 1831615343 | Donna Marie Dugan | Counselor | South Bay Community Services, 340 Main Street - Suite 818, Worcester, MA 02301 | 2017-08-16 |
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| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1043441611 | Commonwealth of Ma, D/b/a Brockton Multi-service Center | Clinic/Center | 165 Quincy St, Brockton, MA 02302-2988 | 2009-07-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.