| NPI | 1881158988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ICE Chief Medical Officer 215-482-3036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |