| NPI | 1124809975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA V ISAAC Employee 917-975-5662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2023-10-09 |