| NPI | 1518485812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISSA A MALEY Owner 347-837-2501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 1381) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NM 1381) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NM 1381) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NM 1381) | |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2017-09-07 |