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General NPI Number Information
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NPI Number | 1558706598
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Entity Type | Organization
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Legal Business Name | SOUTH BAY MENTAL HEALTH
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 80 OLD STONE WAY APT 309
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City | EAST WEYMOUTH
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State | MA
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Zip | 02189-2539
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Country | US
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Telephone | 518-253-3435
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Fax |
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Provider Business Mailing Address
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Address Line | 80 OLD STONE WAY APT 309
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City | EAST WEYMOUTH
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State | MA
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Zip | 02189-2539
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Country | US
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Telephone | 518-253-3435
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Fax |
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Authorized Official
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Title or Position | MASTER'S LEVEL THERAPISTS
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Name | MS. CHARLOTTE N WODI
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Credential | MSW
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Telephone | 518-253-3435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 3
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License Number State | MA
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