| NPI | 1134722655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA L MCCORMACK Co Owner 617-901-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 104100000X Social Worker |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent | |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2020-11-18 |