| NPI | 1821257460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME RENE WILETT Owner 315-472-9042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 005499-1) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-07-23 |