Provider Demographics
NPI:1588062244
Name:SOUTH SHORE PSYCHIATRIC SERVICES PC
Entity type:Organization
Organization Name:SOUTH SHORE PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RNCS, FPNP
Authorized Official - Phone:781-837-8833
Mailing Address - Street 1:435 FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2328
Mailing Address - Country:US
Mailing Address - Phone:781-837-8833
Mailing Address - Fax:781-735-0457
Practice Address - Street 1:435 FURNACE ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2328
Practice Address - Country:US
Practice Address - Phone:781-837-8833
Practice Address - Fax:781-735-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198161364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty