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General NPI Number Information
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NPI Number | 1033294558
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Entity Type | Organization
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Legal Business Name | SOUTH BAY MENTAL HEALTH CENTER, INC.
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 1115 WEST CHESTNUT STREET SUITE 202
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 508-521-2200
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Fax | 508-584-2227
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Provider Business Mailing Address
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Address Line | 1115 WEST CHESTNUT STREET SUITE 202
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 508-521-2200
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Fax | 508-584-2227
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Authorized Official
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Title or Position | PRESIDENT/COO
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Name | SARA J HART
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Credential | LMHC
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Telephone | 508-324-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 4222
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License Number State | MA
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