| NPI | 1821461609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT DONOFRIO Director 575-418-8109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA08893200) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NJ 25MA08893200) |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: NJ 25MA08893200) | |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: NJ 25MA08893200) | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NJ 25MA08893200) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NJ 25MA08893200) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NJ 25MA08893200) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: NJ 25MA08893200) | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2016-01-14 |