| NPI | 1396802567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER A JACONSKI Billing Representative 301-953-1266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-12-27 |