SOUTH SHORE MENTAL HEALTH (NPI# 1417051780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417051780 |
| Entity Type | Organization |
| Organization Name | SOUTH SHORE MENTAL HEALTH |
| Practice Address |
500 Victory Rd Quincy MA 02171-3139 |
| Practice Telephone | 6178471926 |
| Mailing Telephone | 6178471926 |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. LU FERNANDEZ (SUPERVISOR) |
| Authorized Official Telephone | 6178471926 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | 1025460 | MA | Managed Care Organizations |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982159000 | South Shore Mental Health | Community/Behavioral Health | 17 Elm Pl, Whitman, MA 02382-2427 | 2016-08-18 |
| 1114280286 | South Shore Mental Health | Exclusive Provider Organization | 16 Penniman Circle, Stoughton, MA 02072 | 2012-06-22 |
| 1134207657 | South Shore Mental Health | Community/Behavioral Health | 8 Hancock Ct, Quincy, MA 02169-5210 | 2006-11-01 |
| 1851480891 | South Shore Mental Health | Public Health or Welfare | 4820 Swanns Mill Dr, Durham, NC 27704-1492 | 2006-10-11 |
| 1790820678 | South Shore Mental Health | Case Management | 8 Hancock Ct, Quincy, MA 02169-5210 | 2007-02-20 |
| 1881769024 | South Shore Mental Health | Community/Behavioral Health | 460 Quincy Ave, Quincy, MA 02169-8130 | 2006-11-22 |
| 1356412092 | South Shore Mental Health | Community/Behavioral Health | 12 Hancock Ct, Quincy, MA 02169 | 2006-11-13 |
| 1902818826 | South Shore Mental Health | Preferred Provider Organization | 310 Barnstable Rd, Hyannis, MA 02601-2902 | 2006-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTH SHORE MENTAL HEALTH | 500 Victory Rd, Quincy, MA 02171-3139 |
| New York State Corporations | SOUTH SHORE MENTAL HEALTH COUNSELING SERVICES P.C. | 74 Beaver Dam Road, Islip, New York 11751 |
| Street Address |
500 VICTORY RD |
| City | QUINCY |
| State | MA |
| Zip Code | 02171-3139 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265462477 | Ajita Purohit | Social Worker | 500 Victory Rd, Bayview Associates, Quincy, MA 02171-3139 | 2006-07-04 |
| 1265030191 | Benjamin Miele | Counselor | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-10-13 |
| 1447861364 | Juliana Lee Willey | Counselor | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-08-13 |
| 1437760725 | John Francis Mannion | Registered Nurse | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-08-11 |
| 1306456488 | Abigail R Hennigan | Music Therapist | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-08-04 |
| 1225647191 | Delaney Elaine Hauck | Social Worker | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-07-27 |
| 1760007090 | Lorain Clair Baeumler | Registered Nurse | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-06-12 |
| 1346865052 | Kyle Christopher Leonard | Counselor | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-06-09 |
| 1649895400 | Jessica Anderson | Counselor | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-06-08 |
| 1669094884 | Lisa Lopes | Counselor | 500 Victory Rd, Quincy, MA 02171-3139 | 2020-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730661190 | Yvonne Ann Roth | Social Worker | 1 Enterprise Drive, Quincy, MA 02171 | 2018-09-03 |
| 1902397631 | Kristen Spain | Registered Nurse | 110 West Squantum St., North Quincy, MA 02171 | 2018-05-29 |
| 1760984777 | Oumaima Mansouri | Counselor | 110 West Squantum Street, Quincy, MA 02171 | 2018-03-06 |
| 1386163699 | Sophonie Belizaire | Assistant Behavior Analyst | South Shore Mental Health, 500 Victory Rd., Quincy, MA 02171 | 2017-09-18 |
| 1306209168 | Katherine R Standish | Family Medicine | 110 W Squantum St Ste 8, North Quincy, MA 02171 | 2016-03-30 |
| 1669852778 | Joseph Odom | Counselor | 43 Old Colony Road, Quincy, MA 02171 | 2015-06-03 |
| 1578825436 | Hoi Yuk Pang | Counselor | 1 Billings Rd, Quincy, MA 02171 | 2012-06-15 |
| 1275862526 | Naeemah Tahira Smith | Counselor | 210a Quincy Shore Dr, Quincy, MA 02171 | 2009-12-16 |
| 1386876779 | Mark Everds | Counselor | 97 Holmes Street, 2nd Floor, North Quincy, MA 02171 | 2009-08-18 |
| 1306014741 | Ping-chiu Chan | Acupuncturist | Chinese Medical Center, 38 Billings Road, Quincy, MA 02171 | 2008-02-20 |
| Find all providers in zip 02171 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
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| 1316369622 | Consolidated Health Plan | Preferred Provider Organization | 2077 Roosevelt Ave, Springfield, MA 01104-1657 | 2014-01-07 |
| 1992131528 | Rockn Kids Dental | Preferred Provider Organization | 51 Galen St, Watertown, MA 02472-4503 | 2013-09-14 |
| 1417399270 | Wahid Mistikawi Dba Greatwoods Family Dentistry | Preferred Provider Organization | 792south Main St, 24, Mansfield, MA 02048-3137 | 2013-07-22 |
| 1114211083 | D. James Thomas Ministries Inc | Preferred Provider Organization | 121 Hazelton St, Mattapan, MA 02126-3135 | 2011-06-07 |
| 1376879197 | Cheri Gaffney | Preferred Provider Organization | 7 Rolling Ridge Rd, Rutland, MA 01543-1782 | 2009-10-29 |
| Find all providers with the same taxonomy | ||||
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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.