| NPI | 1518081108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEDA EBRAHIMI-KESHISHIAN President 617-547-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: MA MB-PRF-914) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 6214) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 6214) | |
| 103TF0000X Psychologist, Family (Licence: MA 6214) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 6214) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 6214) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2014-11-14 |