| NPI | 1518996354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA A TAVARES Director Of Credentialing 774-628-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2025-09-30 |