| NPI | 1003280140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHADIJAH TILLMAN Psychotherapist 585-713-2071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73081603) |
| Enumeration Date | 2015-11-29 |
| Last Update Date | 2015-11-29 |