Provider Demographics
NPI:1750703062
Name:SOUTH BAY MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:SOUTH BAY MENTAL HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-324-0328
Mailing Address - Street 1:1115 WEST CHESTNUT STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-521-2200
Mailing Address - Fax:508-584-2227
Practice Address - Street 1:1115 WEST CHESTNUT STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-521-2200
Practice Address - Fax:508-584-2227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY INTERVENTION SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-07
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency