| NPI | 1477136513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE DEJESUS Provider 774-300-3444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2024-02-07 |