| NPI | 1912613373 |
|---|---|
| Other Name | MONGOOSE THERAPY, LLC |
| Entity Type | Organization |
| Authorized Contact | NICHOLAS HEATH Licsw 617-320-3876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2025-06-16 |