| NPI | 1134050487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE MARIA BURGOS-JUTERAM Pmhnp 754-329-5644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2026-05-26 |
| Last Update Date | 2026-05-26 |