The Commonwealth of Massachusetts
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Brockton, MA
NPI 1326155458 · NPPES record last updated May 3, 2023
Key facts
- NPI
- 1326155458
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- THE COMMONWEALTH OF MASSACHUSETTS
- Practice address
- 165 Quincy St
Brockton, MA 02302-2988 - Phone
- (508) 897-2069
- NPI assigned
- Aug 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Mona Mackinnon
- Title
- Center Director
- Phone
- (774) 297-3246
Owned or controlled facilities with NPI records 11
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 24
Practitioners 165
-
Mark P Caron, LICSW
-
Anne Mary Carter, M.D.
-
Marc Allan Cohen, LICSW
-
James Fay, LCSW
-
Marc Gagnier, MD
-
Kathleen Heffernan, APN
-
Ryan Francis Horn, LICSW
-
Ronald Tae Lee, M.D.
-
Michael Francis Luongo, LCSW, MSW, BS,
-
Dayina Noel Turner, PMHNP
-
Kiara Rossborough, LICSW
-
Michelle Smith, LICSW
-
Genny I Wolf, D.O.
-
Giancarlo D Zolfonoon, PMHNP
-
Andrew C Bott, M.D.
-
Rafael Ivan Gracia, M.D.
-
Joseph A. Santos Afonso, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Tewksbury Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 1966 |
| Lemuel Shattuck Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| Dr. John C Corrigan Mental Health Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Feb 2, 1989 |
| Solomon Carter Fuller Mental Health Center |
Hospital | Operational/Managerial Control (100%) | Dec 26, 2008 |
| Worcester Recovery Center and Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 17, 1992 |
| Cape Cod and the Islands Mental Health Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Feb 2, 1989 |
| Taunton State Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1986 |
| Massachusetts Veterans' Home in Chelsea |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 1, 2023 Jul 1, 1966 |
| Massachusetts Veterans' Home of Holyoke |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
May 6, 2025 May 6, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050203000148 | MA | Part B Supplier - Clinic/Group Practice | 8820906860 |
Receives reassigned benefits from 23 practitioners Practice locations: Brockton, MA; Norton, MA; Plymouth, MA |
National Provider Directory
- Tax ID family
- C Stanley Raymond
Locations
40 Industrial Park Rd
Plymouth, MA 02360
Phone (508) 732-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | MA | Yes | |
| Pharmacy | 333600000X | |||
| Clinic Pharmacy | 3336C0002X |
Addresses
Primary practice location
165 Quincy St
Brockton, MA 02302-2988
Mailing address
165 Quincy St
Brockton, MA 02302-2988
Phone (508) 897-2069
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1305565 | Medicaid | MA | |
| 2155167 | Other | PK |
Other names
- Brockton Multi Service center
Other providers in Brockton, MA
- Sejal Thakor
- Fred J Thaler
- Remya Tharackal-Ravindran
- Heather Tharpe-Bush
- The Bridge to Life Resources Inc
- The Lactation Network, LLC
- The Lamplighter Center for Renewal, Inc.
- The Light Time Gift Health Care
- The Pacific Home Health Aide Inc
- The Stork'S Helpers
All providers in Brockton, MA · Mental Health Clinic/Center (Including Community Mental Health Center) in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.