| NPI | 1770003048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA BARNA Licensed Clinical Social Worker 848-200-5533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103T00000X Psychologist |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-21 |