| NPI | 1851758239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEANNA FORTUNATO Clinical Psychologist 734-657-0467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071008199) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2016-01-15 |