| NPI | 1528727757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA BOATENG-WILSON Owner 917-488-7910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2023-04-17 |