| NPI | 1033402920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD MICHAEL RONSISVALLE President 321-259-1662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY6964) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2016-08-16 |