| NPI | 1629237508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA G. COOPER Program Director 631-691-0769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 044-673-D) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |