| NPI | 1003674367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA TEDESCO Therapist 732-993-8164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-03-11 |