| Bay State Community Services, Inc. | |
|
1120 Hancock St Quincy MA 02169-4313 | |
| (617) 471-8400 | |
| (617) 376-0456 |
| Full Name | Bay State Community Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1120 Hancock St, Quincy, Massachusetts |
| Authorized Official Name and Position | Daurice Cox (CEO) |
| Authorized Official Contact | 6174718400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bay State Community Services, Inc. 1120 Hancock St Quincy MA 02169-4313 Ph: (617) 471-8400 | Bay State Community Services, Inc. 1120 Hancock St Quincy MA 02169-4313 Ph: (617) 471-8400 |
| NPI Number | 1134126865 |
|---|---|
| Provider Enumeration Date | 07/07/2005 |
| Last Update Date | 04/01/2015 |
| Medicare PECOS PAC ID | 2062450307 |
|---|---|
| Medicare Enrollment ID | O20050419000146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134126865 | NPI | - | NPPES |
| 000000008418 | Other | MA | BOSTON MEDICAL HEALTHNET |
| 110027843/B | Medicaid | MA | |
| 110027843C | Medicaid | MA | |
| 110027843D | Medicaid | MA | |
| 613043 | Other | MA | TUFTS HEALTH PLAN |
| 110027843/A | Medicaid | MA | |
| 1003840 | Other | MA | BEACON HEALTH - NHP |
| 99622801 | Other | MA | NETWORK HEALTH |
| 110027843E | Medicaid | MA |
| Provider Name | Susan Rovaine Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710969233 PECOS PAC ID: 5799761292 Enrollment ID: I20040625000589 |
| Provider Name | Vanessa Chavez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588093397 PECOS PAC ID: 1658622709 Enrollment ID: I20180928001016 |
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