| NPI | 1780838060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA J NELSON Sole Mbr 917-863-3780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: NY 061668-1) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2008-11-12 |