Provider Demographics
NPI:1639572779
Name:SOUTH SHORE MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:SOUTH SHORE MENTAL HEALTH, INC.
Other - Org Name:STEP ONE EARLY INTERVENTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-847-1950
Mailing Address - Street 1:500 VICTORY ROAD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-3139
Mailing Address - Country:US
Mailing Address - Phone:617-847-1950
Mailing Address - Fax:617-786-9894
Practice Address - Street 1:2 MOON ISLAND RD
Practice Address - Street 2:
Practice Address - City:SQUANTUM
Practice Address - State:MA
Practice Address - Zip Code:02171-1034
Practice Address - Country:US
Practice Address - Phone:617-847-1950
Practice Address - Fax:617-786-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA459261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
EI0013OtherBLUE CROSS