Provider Demographics
NPI:1780025189
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:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-244-1950
Mailing Address - Street 1:15 S POINT DR
Mailing Address - Street 2:APARTMENT 605
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 S POINT DR
Practice Address - Street 2:APARTMENT 605
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-3564
Practice Address - Country:US
Practice Address - Phone:857-225-6908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization