| NPI | 1043562986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENA K FERGUSON Medical Director 631-509-6111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 230330) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |