| NPI | 1154725141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REVITAL RACIN Psychiatrist 617-993-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MA 258205) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |