| NPI | 1144988098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN SHANNON Owner 617-987-4004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |