| NPI | 1356815179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY FORBES Licensed Clinical Social Worker 315-717-7307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2019-01-15 |