| NPI | 1497828461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE Y HEBERT-BUBLYK Credentialing Specialist 716-947-5025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2019-09-06 |