| NPI | 1669875936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE PROVENZANO Clinical Social Worker 631-487-5162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081438) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |