| NPI | 1487367967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL TIERNEY Medical Director/Owner 855-675-1849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-12-30 |
| Last Update Date | 2023-03-29 |