| NPI | 1154106888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNELL I MOSS Owner/Operator 631-942-9150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-08-30 |