| NPI | 1982120572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISA KOUPERSCHMIDT Medical Director 617-921-0119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 246627) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 000010244) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2018-06-16 |