| NPI | 1811715774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE LADUCA Credentialing Manager 845-702-2711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 208VP0000X | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2025-03-17 |