| NPI | 1831721422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA COURNOYER Credentialing Specialist 401-786-4156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2024-05-08 |