Provider Demographics
NPI:1295413177
Name:MASS BAY BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:MASS BAY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LADC I
Authorized Official - Phone:508-578-8586
Mailing Address - Street 1:346 GIFFORD STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2968
Mailing Address - Country:US
Mailing Address - Phone:508-578-8586
Mailing Address - Fax:
Practice Address - Street 1:346 GIFFORD STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-578-8586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty