Organization
SOUTH BAY MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHAWNTAE NICOLE GRACE (INTAKE LIASON)
(508) 863-1584
Entity
Organization
Contact information
Practice address
1115 W CHESTNUT ST, BROCKTON, MA 02301-7501
(508) 580-4691
Mailing address
1115 W CHESTNUT ST, BROCKTON, MA 02301-7501
(508) 580-4691
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
11/04/2013
Last updated
11/04/2013
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