| NPI | 1033438643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSS MICOLI Corp. Director, Behavioral Health 856-488-6701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2010-05-21 |