| NPI | 1760857056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA JACKSON Licensed Psychologist 518-265-5264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2015-12-11 |