| NPI | 1134977598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA SOSA Payer Credentialing Specialist 401-921-7374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-05-10 |
| Last Update Date | 2024-06-04 |