| NPI | 1659916278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA HENDRICKSON Provider 631-838-7183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-11-07 |