Organization
COMMONWEALTH OF MASSACHUSETTS-DMH
Active
Other names
SOUTH SUBURBAN SITE
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON COLE (SITE DIRECTOR)
(617) 626-9023
Entity
Organization
Contact information
Practice address
460 QUINCY AVE, QUINCY, MA 02169-8130
(617) 626-9018
Mailing address
460 QUINCY AVE, QUINCY, MA 02169-8130
(617) 626-9018
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1802402
—
MA
Enumeration date
03/29/2007
Last updated
08/27/2007
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