Provider Demographics
NPI:1437101839
Name:BROCKTON AREA MULTI-SERVICES, INC.
Entity Type:Organization
Organization Name:BROCKTON AREA MULTI-SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-580-8700
Mailing Address - Street 1:10 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1812
Mailing Address - Country:US
Mailing Address - Phone:508-580-8700
Mailing Address - Fax:508-580-3114
Practice Address - Street 1:288 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1820
Practice Address - Country:US
Practice Address - Phone:781-447-6425
Practice Address - Fax:781-447-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20019Medicare ID - Type UnspecifiedOUTPATIENT MENTAL HEALTH
MAY10399Medicare ID - Type UnspecifiedOUTPATIENT MENTAL HEALTH
MAP30002Medicare ID - Type UnspecifiedOUTPATIENT MENTAL HEALTH
MAW40002Medicare ID - Type UnspecifiedOUTPATIENT MENTAL HEALTH