| NPI | 1083012074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN CANNONE Owner 888-660-4425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2024-04-09 |