| NPI | 1710929047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANTOSH J DEWAN President 315-464-3119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-08-22 |