Provider Demographics
NPI:1447395694
Name:MASS BAY ENTERPRISES LLC
Entity Type:Organization
Organization Name:MASS BAY ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:MCQUINN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-238-5766
Mailing Address - Street 1:45 EASTMAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1279
Mailing Address - Country:US
Mailing Address - Phone:508-238-5766
Mailing Address - Fax:508-238-8045
Practice Address - Street 1:45 EASTMAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1279
Practice Address - Country:US
Practice Address - Phone:508-238-5766
Practice Address - Fax:508-238-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty