| NPI | 1699251496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH LACY Partner 347-443-5512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2018-07-15 |