| NPI | 1811049265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A MANCUSO Owner 315-735-8913 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 061210754) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2020-08-22 |