Provider Demographics
NPI:1912324369
Name:SOUTH BAY MENTAL HEALTH
Entity Type:Organization
Organization Name:SOUTH BAY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMNET COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:NII
Authorized Official - Last Name:LAMPTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-228-8808
Mailing Address - Street 1:49A FARRAR AVE
Mailing Address - Street 2:APT IL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3272
Mailing Address - Country:US
Mailing Address - Phone:774-228-8808
Mailing Address - Fax:
Practice Address - Street 1:49A FARRAR AVE
Practice Address - Street 2:APT IL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3272
Practice Address - Country:US
Practice Address - Phone:774-228-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health