| NPI | 1477956837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DAVIDSON Ba 856-453-1882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 40611) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 538341) |
| 225100000X Physical Therapist (Licence: NJ 40QA00518300) | |
| 225X00000X Occupational Therapist (Licence: NJ 46TR00264300) | |
| 235Z00000X Speech-Language Pathologist, (Licence: NJ 89331) | |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |