| NPI | 1508098732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J. RYAN FULLER Clinical Director 646-495-3078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 017620) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2009-08-21 |