| NPI | 1164291860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN MONTGOMERY Credentialing 215-997-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-12-22 |
| Last Update Date | 2023-12-22 |