| NPI | 1033581517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAX BANILIVY Psychologist 631-920-8164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NY 41309) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2015-10-23 |