| NPI | 1740654870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY HOFFMAN Provider 917-602-2741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 002657) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2024-07-20 |