South Shore Mental Health
Exclusive Provider Organization in Stoughton, MA. Organization (NPI-2).
NPI number1114280286
StatusActive
Last updated in NPPESJun 22, 2012
Details
- NPI
- 1114280286
- Entity type
- Organization (NPI-2)
- Legal business name
- South Shore Mental Health
- Organization subpart
- No
- Enumeration date
- Jun 22, 2012
- Last updated
- Jun 22, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | – | – | Yes |
Practice location
16 Penniman CircleStoughton, MA 02072
Phone 781-408-6056
Mailing address
16 Penniman CirStoughton, MA 02072-3564
Authorized official
Jonathan Prone
Family Support Worker
5085804691
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