| NPI | 1801348016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JELAN A AGNEW Therapist 347-429-5909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 008581) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2016-11-04 |