| NPI | 1083865117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY A FRATRICK Manager 239-810-3998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW5602) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2011-08-01 |