| NPI | 1184040123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN FERRERA Director 917-300-8006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018945) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 018945) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 018945) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 018945) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 018945) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NY 018945) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 018945) | |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-03-14 |