| NPI | 1275811291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD T GARDINER Owner 315-472-7885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2011-07-25 |