| NPI | 1194263632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIELLE PAIGE HACKETT Owner 954-812-3482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9507) |
| Enumeration Date | 2017-02-04 |
| Last Update Date | 2022-06-07 |