| NPI | 1396381539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR THOMPSON Mentor 617-785-9459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2019-11-22 |