NPI | 1538731369 |
---|---|
Former Name | JENNIFER LYNNE MANDATO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 37240) |
Enumeration Date | 2021-07-12 |
Last Update Date | 2021-07-12 |