| NPI | 1033364039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN ICE Psychotherapist 239-273-3915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW5007) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2009-03-14 |