| NPI | 1790236230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI DANIELLE MACK Senior Staff Therapist 315-282-7076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000918) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |