| NPI | 1609326206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN KELSCH Clinical Social Worker 631-875-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077692) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |