Provider Demographics
NPI:1508077496
Name:SOUTH BAY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH BAY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONIKAS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:508-752-3936
Mailing Address - Street 1:14 MENDON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4804
Mailing Address - Country:US
Mailing Address - Phone:508-847-0480
Mailing Address - Fax:
Practice Address - Street 1:332 MAIN ST
Practice Address - Street 2:30
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1517
Practice Address - Country:US
Practice Address - Phone:508-752-3969
Practice Address - Fax:508-725-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management