SOUTH SHORE MENTAL HEALTH (NPI# 1881769024) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881769024 |
| Entity Type | Organization |
| Organization Name | SOUTH SHORE MENTAL HEALTH |
| Practice Address |
460 Quincy Ave Quincy MA 02169-8130 |
| Mailing Address |
20 Mead St # 2 Cambridge MA 02140-2014 |
| Practice Telephone | 6177746036 |
| Mailing Telephone | 6178681472 |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. LUZ FERNANDEZ (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 6178471926 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 110660 | MA | Agencies |
| 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 |
| 1356412092 | South Shore Mental Health | Community/Behavioral Health | 12 Hancock Ct, Quincy, MA 02169 | 2006-11-13 |
| 1417051780 | South Shore Mental Health | Preferred Provider Organization | 500 Victory Rd, Quincy, MA 02171-3139 | 2006-09-08 |
| 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 |
460 QUINCY AVE |
| City | QUINCY |
| State | MA |
| Zip Code | 02169-8130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407884059 | The Commonwealth of Massachusetts | Psychiatric Hospital | 460 Quincy Ave, Quincy, MA 02169-8130 | 2006-06-30 |
| 1285235200 | Veneza Monteiro | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-11-05 |
| 1821605429 | Christopher Peter Wallack I | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-09-28 |
| 1689285561 | Angela Wang | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-08-13 |
| 1336767813 | Priscilla Gouldbourne | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-07-10 |
| 1083231351 | Christine Leigh Dipaolo | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-07-02 |
| 1245853860 | Sally Ann Potkay | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-05-19 |
| 1669093456 | Ashley Sullivan | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-05-03 |
| 1003448457 | Tom F Chappuis Jr. | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-02-04 |
| 1528699154 | Theresa Lepore | Counselor | 460 Quincy Ave, Quincy, MA 02169-8130 | 2020-02-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902427933 | Trinasia Jones | Counselor | 80 Quarry Street, 3, Quincy, MA 02169 | 2020-04-30 |
| 1164060778 | Bid-milton Physician Associates Inc | Clinic/Center | 100 Walter J. Hannon Pkwy, Quincy, MA 02169 | 2019-12-13 |
| 1669028064 | Renee Yvette Belisle | Occupational Therapist | 1266 Furnance Brook Parkway, Suite #100b, Quincy, MA 02169 | 2019-08-13 |
| 1952953713 | Phuc Thi Diem Ho | Registered Nurse | 18 Rustic Place, Quincy, MA 02169 | 2019-07-11 |
| 1518451939 | Lucille Jordan | Social Worker | 1175 Sea St, Quincy, MA 02169 | 2018-06-19 |
| 1326567447 | Tara Barney | Counselor | 290 Quarry Street Apt. 112, Quincy, MA 02169 | 2017-09-11 |
| 1295251007 | Iona Dental, P.C. (parent Organization) | Dentist | 10 Granite Street, Unit - 4c, Quincy, MA 02169 | 2017-08-15 |
| 1730610247 | Amy S. Chung | Family Medicine | 100 Walter J. Hannon Parkway, Quincy, MA 02169 | 2017-03-26 |
| 1205377314 | Wing Man Ting | Counselor | 2 Moon Island Road, Quincy, MA 02169 | 2017-03-09 |
| 1740726223 | Cameron James Dumas | Pharmacist | 21 23 Stanhope Street, Boston, MA 02169 | 2017-01-09 |
| Find all providers in zip 02169 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518597905 | Forensic Insight Group | Community/Behavioral Health | 1354 Hancock St Ste 300, Quincy, MA 02169-5109 | 2020-01-24 |
| 1669988291 | South Shore Recovery Home | Community/Behavioral Health | 10 Dysart St, Quincy, MA 02169-6702 | 2017-12-19 |
| 1720507700 | Shannon Michelle Reilly | Community/Behavioral Health | 24 Hollis Ave Apt 2r, Quincy, MA 02171-2361 | 2017-09-12 |
| 1184082380 | Preferred Family Healthcare, Inc. | Community/Behavioral Health | 815 Elm St, Frederick Ball Public Housing, Quincy, IL 62301-2365 | 2016-02-02 |
| 1124499074 | Preferred Family Healthcare, Inc. | Community/Behavioral Health | 540 Harrison St, Quincy, IL 62301-7236 | 2015-10-16 |
| 1871969964 | Preferred Family Healthcare, Inc. | Community/Behavioral Health | 639 York St Rm 212, Quincy, IL 62301-3919 | 2015-08-12 |
| 1235559964 | Pyramid Builders Counseling Services, Inc | Community/Behavioral Health | 40 Willard St Ste 304, Quincy, MA 02169-1252 | 2014-04-21 |
| 1225461809 | Fathers' Uplift | Community/Behavioral Health | 145 Willard St Apt A3, Quincy, MA 02169-1533 | 2013-08-18 |
| 1255672192 | Disc Village, Inc. | Community/Behavioral Health | 305b W Crawford St, Quincy, FL 32351-3121 | 2013-03-01 |
| 1720203185 | Baystate Community Services | Community/Behavioral Health | 12 Temple St, Baystate Community Services, Quincy, MA 02169 | 2007-04-13 |
| Find all providers in QUINCY | ||||
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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.