| NPI | 1346877974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RERNGSAMAI Provider/Owner 732-598-6396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-03-30 |