| NPI | 1023999604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN DODGE Authorized Official 617-500-3513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2025-09-10 |