| NPI | 1982838751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CLONTZ Program Director 617-292-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2015-06-08 |