| NPI | 1386155240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY-ANN FAIRWEATHER Owner 347-512-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083105) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-10-18 |