| NPI | 1144561614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN ANTONIO RIOS Owner 203-507-4703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NJ 44SC05461000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05461000) | |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2023-05-09 |