Provider Demographics
NPI:1447500525
Name:SOUTH BAY MENTAL HEALTH
Entity type:Organization
Organization Name:SOUTH BAY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:617-750-1593
Mailing Address - Street 1:72 MONROE ROAD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1925
Mailing Address - Country:US
Mailing Address - Phone:617-750-1593
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-331-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization