| NPI | 1619707650 |
|---|---|
| Other Name | PLLC |
| Entity Type | Organization |
| Authorized Contact | HOLLY LEE GORDON Excutive Director 631-294-0216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-05 |