| NPI | 1467695981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERY EUGENE FRADKOV Therapist 917-582-1683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05391100) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2011-12-12 |