| NPI | 1073096624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROOSEVELT LEWIS Nurse Practitioner / Owner 617-401-7441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251E00000X Home Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-01-21 |