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General NPI Number Information
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NPI Number | 1386963163
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Entity Type | Organization
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Legal Business Name | DIMOCK COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 55 DIMOCK ST
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City | ROXBURY
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State | MA
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Zip | 02119-1029
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Country | US
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Telephone | 617-442-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 62 WYMAN STREET
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130
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Country | US
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Telephone | 617-435-0999
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Fax |
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Authorized Official
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Title or Position | PSCHIATRIC TRIAGE COORDINTOR
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Name | MS. DEBORAH SARAH REID
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Credential | L.C.S.W.
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Telephone | 617-442-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 043487833
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1326193269
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | MA
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