| NPI | 1699580647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHENIE JACKSON-WILSON Owner 617-407-7879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-03-20 |