Organization
CHILD AND FAMILY SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETSY IVELISSE BONILLA LICSW (CLINICAL DIRECTOR)
(617) 320-2511
Entity
Organization
Contact information
Practice address
20 CENTRAL AVE STE 507, LYNN, MA 01901-1201
(617) 320-2511
Mailing address
20 CENTRAL AVE STE 507, LYNN, MA 01901-1201
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
117238
MA
Other
Enumeration date
04/21/2013
Last updated
04/21/2013
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