| NPI | 1114409489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISSA DUTRA Principal 617-307-4470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 9008) |
| 251S00000X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2018-09-04 |