Victory Bay Mental Health Ma LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

VICTORY BAY MENTAL HEALTH MA LLC

Practice address

500 W Cummings Park
Suite 1700 and 1800
Woburn, MA 01801

Phone

(856) 440-9573

NPI assigned

May 24, 2024

Last updated

May 28, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Maccarella

Title

Coo

Phone

(856) 440-7593

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1265271522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 EVES DR STE 100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533196",
            "telephone_number": "856-440-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W CUMMINGS PARK",
            "address_2": "SUITE 1700 AND 1800",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "01801",
            "telephone_number": "856-440-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY BAY MENTAL HEALTH MA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-24",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "MACCARELLA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "856-440-7593"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Woburn, MA
• Providers in Woburn, MA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.