| NPI | 1023522521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYANN FATATA Health Management Systems Specialis 315-927-2117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2018-04-11 |