| NPI | 1366957169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA JILL ELIASON Member 201-416-9383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |