| NPI | 1710748389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA DIXON Administrator 347-933-1741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-02-15 |