| NPI | 1366865255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY DAVISON Clinical Supervisor 518-242-4731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NY 071063-1) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |