NPIMap

Organization Active NPI

South Bay Mental Health

  • Early Intervention Provider Agency
  • Brockton, MA
National Provider Identifier
1487944369
Registry record updated Apr 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
251934 Issued in MA
Legal business name
SOUTH BAY MENTAL HEALTH
Practice address
1115 W Chestnut St
Brockton, MA 02301-7501
Phone
(508) 559-0473
Fax
(508) 427-5361
NPI assigned
Apr 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2011

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

Authorized official

Name
Mrs. Michelle Nunes Fonseca, RN
Title
Nurse
Phone
(508) 559-0473

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 251934 MA Primary

Addresses

Primary practice location

1115 W Chestnut St
Brockton, MA 02301-7501

Mailing address

133 Centre Ave
Abington, MA 02351-2254
Phone (508) 380-3696

Other names 1

  • SOUTH BAY EARLY INTERVENTION Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1487944369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 CENTRE AVE",
            "city": "ABINGTON",
            "state": "MA",
            "postal_code": "023512254",
            "telephone_number": "508-380-3696",
            "fax_number": "508-427-5361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W CHESTNUT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017501",
            "telephone_number": "508-559-0473",
            "fax_number": "508-427-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-13",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "FONSECA",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "NUNES",
        "authorized_official_title_or_position": "NURSE",
        "authorized_official_telephone_number": "508-559-0473",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "MA",
            "license": "251934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH BAY EARLY INTERVENTION",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; 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.