| NPI | 1184410300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY J WILBRAHAM Owner/Managing Provider 617-362-6848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-06-27 |