| NPI | 1508026477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY-JANE QUICK Billing Supervisor 772-384-1517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 68994) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME 68994) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2011-03-21 |