| NPI | 1396177689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN MICHELLE GODES Owner 617-512-8673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MA 113463) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2013-08-08 |