| NPI | 1770032302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARJORIE RUSSELL Provider 518-389-6606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F401959-1) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2016-09-23 |