| NPI | 1427029297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JANE COPPOLA Credentialing COO Rdinator 617-332-2047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 1041C0700X Social Worker Clinical | |
| 163WP0808X Registered Nurse Psychiatric/Mental Health | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-07-26 |