| NPI | 1568622785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHATHAN SULKIN Owner/Provider 518-580-9863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |