| NPI | 1154602878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY ELIZABETH FODOR President 772-766-2069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW3798) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2011-09-08 |