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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KRIS SANBORN (CLINICAL SOCIAL WORKER)
(617) 629-6793
Entity
Organization

Contact information

Practice address
11 WARD STREET, SECOND FLOOR, SOMERVILLE, MA 02143-4214
(617) 629-6793
Mailing address
11 WARD ST, 2ND FLOOR,, SOMERVILLE, MA 02143-4214

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MA

Other

Enumeration date
06/30/2011
Last updated
06/30/2011
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