MEDICARE: SOUTH BAY MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	3	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	131823394	OTHER	NY	NONE

General Provider Information

NPI Number	:	1558706598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BAY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	80 OLD STONE WAY APT 309
Second Line	:
City	:	EAST WEYMOUTH
State	:	MA
Zip	:	02189-2539
Country	:	US
Telephone Number	:	518-253-3435
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 OLD STONE WAY APT 309
Second Line	:
City	:	EAST WEYMOUTH
State	:	MA
Zip	:	02189-2539
Country	:	US
Telephone Number	:	518-253-3435
Fax Number	:

Authorized Official
Title or Position	:	MASTER'S LEVEL THERAPISTS
Name	:	MS. CHARLOTTE N WODI
Credential	:	MSW
Telephone Number	:	518-253-3435

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	07/21/2022

Similar Medicare Providers

1063221166 — TASHLEY KEISHA FONROSE
Practice Location Address:

80 OLD STONE WAY APT 307
WEYMOUTH, MA
02189-2539

Practice Phone: 857-544-9698
Practice Fax:

1457378986 — MRS. ROCHELLE ALTARAC PACHMAN LCSW
Practice Location Address:

2539 MIDDLE COUNTRY RD , SUITE 4 EAST END NEUROPSYCHIATRIC ASSOC
CENTEREACH, NY
11720-3551

Practice Phone: 631-737-6434
Practice Fax: 631-738-1226

1659420081 — NINA WACHTEL RD
Practice Location Address:

400 TITUS WAY
EAST WILLISTON, NY
11596-2539

Practice Phone: 516-746-0553
Practice Fax: 516-746-0553

1588874572 — SHAMANIQUE RAMIKA BRYANT STNA
Practice Location Address:

1341 E 143RD ST
EAST CLEVELAND, OH
44112-2539

Practice Phone: 216-799-8757
Practice Fax:

1942439674 — RONAK KIRAN TALATI MD
Practice Location Address:

150 EAST SUNRISE HWY
LINDENHURST, NY
11757-2539

Practice Phone: 631-225-7200
Practice Fax:

1407124902 — MRS. THERESA ANN ARNONE I LCSW
Practice Location Address:

2201 DEVON ST
EAST MEADOW, NY
11554-2539

Practice Phone: 516-228-5300
Practice Fax:

Directions to “SOUTH BAY MENTAL HEALTH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.