| 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 |