Healthcare Provider Details

I. General information

NPI: 1902976798
Provider Name (Legal Business Name): SOUTH SHORE MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WASHINGTON ST
NORWELL MA
02061-9147
US

IV. Provider business mailing address

75 WASHINGTON ST
NORWELL MA
02061-1795
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-5200
  • Fax:
Mailing address:
  • Phone: 781-878-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. DETTA HALPIN
Title or Position: CREDENTIALING COORDINATOR
Credential: BS
Phone: 781-792-4191