| NPI | 1487181863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAEANNE MANCHESTER Licsw,Cadc 1 ,Ladc 1 774-955-4115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2017-05-17 |