| NPI | 1679074074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS C WALTHALL Licensed Clinical Social Worker 631-491-5720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 051661) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 9438) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2018-02-22 |