| NPI | 1861047292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHADIJAH ELLA TILLMAN Clinical Social Worker 585-713-2071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| 101YM0800X Counselor, Mental Health | |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2019-08-02 |