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General NPI Number Information
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NPI Number | 1699063412
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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 | 07/13/2011
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 1115 W CHESTNUT ST
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City | BROCKTON
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State | MA
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Zip | 02301-7501
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Country | US
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Telephone | 508-521-2205
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 W CHESTNUT ST
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City | BROCKTON
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State | MA
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Zip | 02301-7501
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Country | US
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Telephone | 508-521-2205
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MOLLY SLOATE-DOWDEN
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Credential |
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Telephone | 518-651-4886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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