| NPI | 1194297788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN DEJESUS Licensed Clinical Social Worker 863-991-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2023-05-20 |