| NPI | 1700511284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COSSETTE D RAE Director 800-682-6934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2022-07-19 |