| NPI | 1124034558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BALCOM CFO 516-733-7032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 6814100A) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2017-03-31 |