Provider Demographics
NPI:1790820678
Name:SOUTH SHORE MENTAL HEALTH
Entity Type:Organization
Organization Name:SOUTH SHORE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LU
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-769-1926
Mailing Address - Street 1:8 HANCOCK CT
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5210
Mailing Address - Country:US
Mailing Address - Phone:617-769-7230
Mailing Address - Fax:
Practice Address - Street 1:8 HANCOCK CT
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5210
Practice Address - Country:US
Practice Address - Phone:617-769-7230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management