| South Bay Community Services | |
|
1115 West Chestnut Street Suite 202 Brockton MA 02301 | |
| (508) 521-2200 | |
| (508) 584-2227 |
| Full Name | South Bay Community Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1115 West Chestnut Street, Brockton, Massachusetts |
| Authorized Official Name and Position | Sara J Hart (PRESIDENT/COO) |
| Authorized Official Contact | 5083240328 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Bay Community Services 1115 West Chestnut Street Suite 202 Brockton MA 02301 Ph: (508) 521-2200 | South Bay Community Services 1115 West Chestnut Street Suite 202 Brockton MA 02301 Ph: (508) 521-2200 |
| NPI Number | 1023096864 |
|---|---|
| Provider Enumeration Date | 01/03/2006 |
| Last Update Date | 04/01/2019 |
| Medicare PECOS PAC ID | 5395797310 |
|---|---|
| Medicare Enrollment ID | O20050217000395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023096864 | NPI | - | NPPES |
| 1311964 | Medicaid | MA | |
| 1309226 | Medicaid | MA | |
| 1310003 | Medicaid | MA | |
| 1311093 | Medicaid | MA | |
| 1312472 | Medicaid | MA | |
| 1309056 | Medicaid | MA | |
| 1316478 | Medicaid | MA | |
| 1309218 | Medicaid | MA | |
| 1312065 | Medicaid | MA | |
| 1309994 | Medicaid | MA | |
| 1300423 | Medicaid | MA | |
| 1309137 | Medicaid | MA | |
| 1310976 | Medicaid | MA | |
| 1309196 | Medicaid | MA | |
| 1319779 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 4222 (Massachusetts) | Primary |
| Provider Name | Judith Lavigniac |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154340834 PECOS PAC ID: 7517878283 Enrollment ID: I20040524000476 |
| Provider Name | Kerri L Ryder |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1013090430 PECOS PAC ID: 6305878562 Enrollment ID: I20050908000603 |
| Provider Name | Louise E Moore Allgaier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831285774 PECOS PAC ID: 2365457447 Enrollment ID: I20060210000081 |
| Provider Name | Martha J Curtis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972615458 PECOS PAC ID: 2961400585 Enrollment ID: I20061115000154 |
| Provider Name | Deborah B Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184762254 PECOS PAC ID: 7517061609 Enrollment ID: I20070329000373 |
| Provider Name | Evan K Margetson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457436404 PECOS PAC ID: 6608956784 Enrollment ID: I20080102000041 |
| Provider Name | Susan Valente |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780870527 PECOS PAC ID: 4486830460 Enrollment ID: I20110510000305 |
| Provider Name | Andrea Sawyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588944573 PECOS PAC ID: 5698934834 Enrollment ID: I20120308000097 |
| Provider Name | Kristina E Lingertat |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720315963 PECOS PAC ID: 3375706526 Enrollment ID: I20120525000171 |
| Provider Name | Kathryn M Doan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922332816 PECOS PAC ID: 0941453997 Enrollment ID: I20121227000088 |
| Provider Name | Jacqueline M Grenier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770832727 PECOS PAC ID: 0042464547 Enrollment ID: I20130211000160 |
| Provider Name | Jeanne B Norton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013299536 PECOS PAC ID: 6901044957 Enrollment ID: I20130603000269 |
| Provider Name | Christina M Zinna |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1720363534 PECOS PAC ID: 8820231475 Enrollment ID: I20130829000195 |
| Provider Name | Michele M Byrnes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164731006 PECOS PAC ID: 7012140650 Enrollment ID: I20140506000191 |
| Provider Name | Corey J Nigro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205149754 PECOS PAC ID: 7517186315 Enrollment ID: I20140910001852 |
| Provider Name | Olga Lisysyan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588810584 PECOS PAC ID: 3476870510 Enrollment ID: I20150330000281 |
| Provider Name | Joel Langsam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548388952 PECOS PAC ID: 8729307251 Enrollment ID: I20150506000095 |
| Provider Name | Lisa S Palais |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003288515 PECOS PAC ID: 7618272113 Enrollment ID: I20160222001022 |
| Provider Name | Lucia Coale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770616336 PECOS PAC ID: 4688970809 Enrollment ID: I20160314001350 |
| Provider Name | Lindsay E Grossman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609278431 PECOS PAC ID: 0042518003 Enrollment ID: I20160407002116 |
| Provider Name | Guerline Norbrun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376927335 PECOS PAC ID: 8123326345 Enrollment ID: I20160420002347 |
| Provider Name | Wendy P Budwey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164811063 PECOS PAC ID: 6608160866 Enrollment ID: I20160810002006 |
| Provider Name | Amy D Belanger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487973566 PECOS PAC ID: 7113212010 Enrollment ID: I20160816002876 |
| Provider Name | Christin M Shelton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760741391 PECOS PAC ID: 8820384373 Enrollment ID: I20160908002336 |
| Provider Name | Brittany M Eideh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902253347 PECOS PAC ID: 9032497045 Enrollment ID: I20161026001241 |
| Provider Name | Holly A Corrigan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588014203 PECOS PAC ID: 0941588321 Enrollment ID: I20161107000868 |
| Provider Name | Paul S Killion |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982797692 PECOS PAC ID: 7618985326 Enrollment ID: I20170621001936 |
| Provider Name | Kaitlin Ann Burke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366501173 PECOS PAC ID: 3971875618 Enrollment ID: I20170816000634 |
| Provider Name | Nancy E Durkin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144779653 PECOS PAC ID: 1557634334 Enrollment ID: I20170829004159 |
| Provider Name | Laura E Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376867416 PECOS PAC ID: 9234495961 Enrollment ID: I20171113000836 |
| Provider Name | Carly Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780040600 PECOS PAC ID: 9931466158 Enrollment ID: I20171127000818 |
| Provider Name | Katie A Blinn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336529916 PECOS PAC ID: 7810243847 Enrollment ID: I20180705002919 |
| Provider Name | Johnmark A Mangiameli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780037747 PECOS PAC ID: 8123374634 Enrollment ID: I20180712002617 |
| Provider Name | Olivia N Bonanno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720564735 PECOS PAC ID: 4082965827 Enrollment ID: I20180918003373 |
| Provider Name | Sharon G Sedik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508358391 PECOS PAC ID: 5597016261 Enrollment ID: I20180919000525 |
| Provider Name | Nicholas J Collura |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912390121 PECOS PAC ID: 2264786748 Enrollment ID: I20181120001064 |
| Provider Name | Jennifer L Duppert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447743406 PECOS PAC ID: 6406193200 Enrollment ID: I20190201001516 |
| Provider Name | Itoko Kikuchi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235374414 PECOS PAC ID: 9931448693 Enrollment ID: I20190225002842 |
| Provider Name | Natasha A Roy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407108020 PECOS PAC ID: 9931441839 Enrollment ID: I20190424002787 |
| Provider Name | Meredith S Rogerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689169823 PECOS PAC ID: 7517209091 Enrollment ID: I20190502001765 |
| Provider Name | Michael P Delisle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447741293 PECOS PAC ID: 4183056922 Enrollment ID: I20191115000885 |
| Provider Name | Kimberly Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962058362 PECOS PAC ID: 5496188815 Enrollment ID: I20191125002746 |
| Provider Name | Antonio M Brito |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356732416 PECOS PAC ID: 7911335310 Enrollment ID: I20200318001574 |
| Provider Name | Rebecca Macgillivray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255768230 PECOS PAC ID: 9436496411 Enrollment ID: I20200709003488 |
| Provider Name | Joanne M Spadaro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861827982 PECOS PAC ID: 3971926536 Enrollment ID: I20200714002514 |
| Provider Name | Kareem A Hines |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528418456 PECOS PAC ID: 7214351964 Enrollment ID: I20200728001310 |
| Provider Name | Laura Marie Cisler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538670831 PECOS PAC ID: 6800211509 Enrollment ID: I20200728003396 |
| Provider Name | Matthew J Parra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609304732 PECOS PAC ID: 2163847021 Enrollment ID: I20200810001207 |
| Provider Name | Lauren A Peretto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659885036 PECOS PAC ID: 6002236544 Enrollment ID: I20201021002282 |
| Provider Name | Dalena N Tran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821108788 PECOS PAC ID: 3971913526 Enrollment ID: I20201110001677 |
| Provider Name | Emily P Noel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295262368 PECOS PAC ID: 0941612998 Enrollment ID: I20201215002734 |
| Provider Name | Deloris D Fisher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285855361 PECOS PAC ID: 7012233190 Enrollment ID: I20201215003149 |
| Provider Name | Daisy G Leon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598113920 PECOS PAC ID: 3476967753 Enrollment ID: I20210127002672 |
| Provider Name | Stacy A Lalor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588181119 PECOS PAC ID: 8820402100 Enrollment ID: I20210127002691 |
| Provider Name | Jacquelyn M Mayo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760965479 PECOS PAC ID: 5991110793 Enrollment ID: I20210208002308 |
| Provider Name | Karyssa D Bendiksen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487925160 PECOS PAC ID: 0244645497 Enrollment ID: I20210219002161 |
| Provider Name | Melissa L Jodat D'angelo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265744924 PECOS PAC ID: 0941618177 Enrollment ID: I20210428000176 |
| Provider Name | Amanda Kochan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235470832 PECOS PAC ID: 3577972199 Enrollment ID: I20210512001673 |
| Provider Name | Megan M St. Pierre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780044032 PECOS PAC ID: 9032528500 Enrollment ID: I20210513000555 |
Arbour Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9 Shaw Rd, Brockton, MA 02301 Phone: 617-935-4872 | |
Aubrey Lieberman Md Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1342 Belmont St, Suite 105, Brockton, MA 02301 Phone: 508-580-3330 Fax: 508-580-8633 | |
Bmc Community Hospital Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 235 N Pearl St, Brockton, MA 02301 Phone: 508-427-3000 | |
South Bay Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1115 West Chestnut Street Suite 202, Brockton, MA 02301 Phone: 508-521-2200 Fax: 508-584-2227 | |
Bmc Brockton Behavioral Health Center Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 34 N Pearl St, Brockton, MA 02301 Phone: 617-414-5393 | |
Brockton Multi Service Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 165 Quincy St, Dmh, Brockton, MA 02302 Phone: 508-897-2000 Fax: 508-586-5117 |