| NPI | 1710752050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN MONTGOMERY Credentialing Specialist 215-997-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2023-11-16 |