| NPI | 1104623339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANETTA LAROSA Executive Director 516-659-5041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0200X Psychologist, Forensic | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2025-02-26 |