| NPI | 1821833559 |
|---|---|
| Former Legal Business Name | SELF |
| Entity Type | Organization |
| Authorized Contact | DANIELLE BOTELHO Bcba 201-895-1076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2024-12-06 |