| NPI | 1013353341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD WAGNER Therapist 646-957-3581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 69088) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2013-05-14 |