| NPI | 1144757691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE DIETER Billing Manager 603-714-0870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2017-05-15 |