| NPI | 1144863622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE LEIBROCK Medical Billing Specialist 201-556-8210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2019-10-28 |