| NPI | 1295114957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY FISHER Program Director 617-504-8678 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MA 1518996354) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |