| NPI | 1043753874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M CASSIDY Licensed Psychologist 631-748-4659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 011578) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2016-11-28 |