| NPI | 1548711567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE JENNINGS Credentialing Specialist 617-454-4916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0004618) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |