| NPI | 1144800194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL J PARK Owner 646-504-3596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-04-13 |