| NPI | 1093173742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND SHALLBETTER Ph D 718-268-6600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 251S00000X | |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2020-06-08 |