| NPI | 1811398621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL PORT Licensed Clinical Psychologist 872-233-8456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 071.008035) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2014-09-11 |