| NPI | 1396336749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINAMARIE VENISCOFSKI Owner Of Practice 201-304-3117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2021-01-28 |