Provider Demographics
NPI:1124376330
Name:SOUTH BAY MENTAL HEALTH
Entity Type:Organization
Organization Name:SOUTH BAY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CLAUDETTE
Authorized Official - Last Name:DELMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-208-3330
Mailing Address - Street 1:440 COURT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2573
Mailing Address - Country:US
Mailing Address - Phone:774-208-3330
Mailing Address - Fax:
Practice Address - Street 1:1563 N MAIN ST
Practice Address - Street 2:STE 202
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2983
Practice Address - Country:US
Practice Address - Phone:774-365-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization