| NPI | 1144674359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PABLO GUEVARA Director 631-289-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NY 73047593) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-14 |