| NPI | 1124340641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL MOORE Psychiatric Nurse Practitioner 631-848-7104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2011-03-25 |