| NPI | 1285123711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L CLARK Licensed Clinical Social Worker 315-326-0155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R053849) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-10 |