| NPI | 1336673318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CLOSSON Psychologist 631-925-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |