| NPI | 1568118370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN LOUIS DICARLO Credentialing Team Lead 855-324-0885 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-03-02 |