| NPI | 1639587652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA COANE Office Manager 631-681-4754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY F401022) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2023-03-07 |