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General NPI Number Information
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NPI Number | 1154724391
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE FAMILY HEALTH COLLABORATIVE
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 1212 HANCOCK ST 205
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City | QUINCY
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State | MA
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Zip | 02169-4300
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Country | US
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Telephone | 617-745-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 HANCOCK ST 205
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City | QUINCY
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State | MA
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Zip | 02169-4300
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Country | US
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Telephone | 617-745-4100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN DUCLOS
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Credential |
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Telephone | 617-745-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1499
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License Number State | MA
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