| NPI | 1467004333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERUSHA THOMAS Senior Administrator 315-472-5110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2019-07-11 |