| NPI | 1558524660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY M KAVANAUGH Sole Member/Manager 025-404-9534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 424) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2023-05-09 |