| NPI | 1740919018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY A BRODERICK Owner / Clinical Therapist 857-293-1321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-06-14 |