| NPI | 1487059523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN M KULL Director 917-991-8417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR061627-1) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2018-03-17 |