| NPI | 1407048432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN A DOMINGOS Clinical Director 781-559-8444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2019-05-29 |