| NPI | 1255871026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN J DOUPE Secretary 516-784-8744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 007719) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 007404-1) |
| 101YM0800X Counselor, Mental Health (Licence: NY 005125-1) | |
| 302R00000X Health Maintenance Organization (Licence: NY 100120) | |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-03-17 |