| NPI | 1366115552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW GALLUP Director Of Operations 617-905-1269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2022-07-29 |