| NPI | 1801368808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE RUSSO Licensed Clinical Social Worker 607-760-4300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2019-01-02 |