Provider Demographics
NPI:1770841777
Name:SOUTH BAY MENTAL HEALTH
Entity Type:Organization
Organization Name:SOUTH BAY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY SERVICES PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:CINCEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:603-365-1029
Mailing Address - Street 1:26 PINNACLE ST
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1535
Mailing Address - Country:US
Mailing Address - Phone:603-365-1029
Mailing Address - Fax:
Practice Address - Street 1:26 PINNACLE ST
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1535
Practice Address - Country:US
Practice Address - Phone:603-365-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH06CHA84211302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization