Organization
SAYFTEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIC WILDES (CO-OWNER)
(617) 203-7082
Entity
Organization
Contact information
Practice address
12 SEWALL AVE, BROOKLINE, MA 02446-5102
(617) 333-8742
(857) 800-8263
Mailing address
12 SEWALL AVE, BROOKLINE, MA 02446-5102
(617) 333-8742
(857) 800-8263
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
7118
MA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
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Other
Enumeration date
11/07/2018
Last updated
09/06/2023
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