| NPI | 1871204073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL E JOHNSON Managing Member 646-645-2108 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2022-12-08 |