| NPI | 1518367457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY FIROUZTALE Member 631-432-8424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078295-1) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2021-05-03 |