| NPI | 1225579162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE PROVENCHER Owner 732-876-3094 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04823100) |
| Enumeration Date | 2017-03-11 |
| Last Update Date | 2017-03-11 |