| NPI | 1497190789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS ISRAEL PEREZ BENITEZ Clinical Psychologist 867-467-7006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8052) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2022-01-21 |