| NPI | 1023623352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BUCKLEY Owner 617-302-7102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2020-09-14 |