| NPI | 1073617353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARINA KAGAN Billing Manager 781-761-5208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 1041C0700X Social Worker Clinical | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2022-06-29 |