| NPI | 1619696606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN LOUIS DICARLO Credentialing Assistant Manager 855-324-0885 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103T00000X Psychologist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2022-08-24 |