| NPI | 1184758211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TED HERON Manager 978-922-2046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 2347) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 2347) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |