| NPI | 1073633327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDY SUE KOPOLOW President 617-972-5055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8603) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 851) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY5819) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2013-04-04 |