| NPI | 1790425387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE AUDRA JACOBSON Licensed Clinical Social Worker 516-528-3831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2022-10-31 |