Provider Demographics
NPI:1184504847
Name:CITY OF BROCKTON HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CITY OF BROCKTON HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDESIR
Authorized Official - Suffix:
Authorized Official - Credentials:PH D MPH
Authorized Official - Phone:508-894-1481
Mailing Address - Street 1:45 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4052
Mailing Address - Country:US
Mailing Address - Phone:508-894-1481
Mailing Address - Fax:508-941-0255
Practice Address - Street 1:60 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4314
Practice Address - Country:US
Practice Address - Phone:508-580-1715
Practice Address - Fax:508-941-0255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BROCKTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty