| NPI | 1558979377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENNILLE BRAITHWAITE Office Mgr 631-400-9251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-07-21 |