| NPI | 1801087226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WACKS Owner 781-861-6767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 28783) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 3999) |
| 1041C0700X Social Worker Clinical (Licence: MA 1023844) | |
| 1041C0700X Social Worker Clinical (Licence: MA 110987) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2007-08-14 |