| NPI | 1861369977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAXIMO DE LA CRUZ Chief Director 571-572-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2025-10-22 |