Provider Demographics
NPI:1124737382
Name:SOUTH SHORE MENTAL HEALTH, INC.
Entity type:Organization
Organization Name:SOUTH SHORE MENTAL HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-847-1994
Mailing Address - Street 1:1501 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7599
Mailing Address - Country:US
Mailing Address - Phone:617-847-1950
Mailing Address - Fax:
Practice Address - Street 1:460 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8130
Practice Address - Country:US
Practice Address - Phone:617-847-1950
Practice Address - Fax:617-786-9894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH SHORE MENTAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026069Medicaid