| NPI | 1104488469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALY GRULLON Organizer 347-674-0797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-07-07 |
| Last Update Date | 2024-05-01 |