| NPI | 1063223311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSELLE O'BRIEN Director 857-225-9759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |