| NPI | 1407323447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER ILLER Therapist 617-803-0644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2018-10-29 |