| NPI | 1992665723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY RENEE GENZLER Credentialing Supervisor 508-663-3852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-11-14 |
| Last Update Date | 2025-11-26 |