| NPI | 1831632595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE JENNINGS Credentialing Specialist 617-454-4916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G84327) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2016-11-29 |