| NPI | 1093472581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA REYES Practice Manager 440-364-4741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2024-01-30 |