| NPI | 1083136683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAINE KEEGAN BAKER Clinical Social Worker 631-833-5677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085486) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2017-07-14 |