Organization
THE HOME FOR LITTLE WANDERERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KACEY BONGARZONE (CLINICIAN)
(617) 302-7814
Entity
Organization
Contact information
Practice address
19 DALRYMPLE ST, UNIT D, JAMAICA PLAIN, MA 02130-4543
(617) 302-7814
Mailing address
19 DALRYMPLE ST, UNIT D, JAMAICA PLAIN, MA 02130-4543
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/23/2015
Last updated
11/23/2015
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