| NPI | 1013769058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADELINE TAKOH NGUM MANGWA Owner/Provider 917-979-8759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2025-06-16 |