| NPI | 1508286873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GOLDER Medical Director 855-767-7287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 268082) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019998) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 017410) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 254324) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2014-07-23 |