| NPI | 1376913400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA KLEIN Director Of Operations 844-422-6336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: CA 39712) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSB4021549) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A112538) | |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2015-10-01 |