Provider Demographics
NPI:1740209881
Name:NORTH SUFFOLK COMMUNITY SERVICES
Entity Type:Organization
Organization Name:NORTH SUFFOLK COMMUNITY SERVICES
Other - Org Name:NORTH SUFFOLK MENTAL HEALTH ASSOCIATION, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CABEZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-912-7910
Mailing Address - Street 1:301 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2807
Mailing Address - Country:US
Mailing Address - Phone:617-889-4860
Mailing Address - Fax:617-889-4635
Practice Address - Street 1:14 PORTER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2116
Practice Address - Country:US
Practice Address - Phone:617-569-3189
Practice Address - Fax:617-569-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4027261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1304178Medicaid
MA7216OtherBMC HEALTHNET
MA1307398Medicaid
MAM18732OtherBLUE CROSS OF MA
MA214325OtherMAGELLAN BEHAVIORAL HLTH
MA708502OtherTUFTS HEALTH PLANS
MA1002420OtherBEACON HEALTH STRATEGIES
MA1301659Medicaid
MA996251-01OtherNETWORK HEALTH
MA1301926Medicaid
MA1303147Medicaid
MAA011775OtherMASS. BEHAVIORAL HEALTH PARTNERSHIP
MAA012487OtherMASS. BEHAVIORAL HEALTH PARTNERSHIP NODDLES ISLAND
MA996251-01OtherNETWORK HEALTH
MAY10045Medicare ID - Type Unspecified
MA1303147Medicaid