Provider Demographics
NPI:1710350913
Name:SOUTH BAY MENTAL HEALTH
Entity Type:Organization
Organization Name:SOUTH BAY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-830-0000
Mailing Address - Street 1:670 ROUTE 6A
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1436
Mailing Address - Country:US
Mailing Address - Phone:508-367-4309
Mailing Address - Fax:508-746-8429
Practice Address - Street 1:670 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1436
Practice Address - Country:US
Practice Address - Phone:508-367-4309
Practice Address - Fax:508-746-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty