| NPI | 1629567581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE BACK Owner 347-377-1855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2019-11-15 |