| NPI | 1003246711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE LUNDIN-ZEMNOVICH Manager 917-406-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL PMT138) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NY 000115-1) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |