| NPI | 1821976341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN CANNONE Cmo 888-705-8722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2025-08-22 |
| Last Update Date | 2025-08-22 |