| NPI | 1013420181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE JEAN LAROCQUE Owner/Manager 617-331-1180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MA 114971) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MA 114971) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2017-11-13 |