| NPI | 1114657665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON ANN MARIA LYAVDANSKY Np 570-331-8372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2024-04-20 |