| NPI | 1639789753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONOR J KENNEDY Owner 158-962-2592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2020-08-04 |