| NPI | 1649760190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUMMER WHITTAKER Credentialing Specialist 617-453-9505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO Psy0003393) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-10 |