| NPI | 1205607744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAXIMO DE LA CRUZ Owner/Director 571-572-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-01-12 |