| NPI | 1306210125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE FALES Office Manager 631-647-9011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 008096-1) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-17 |