| NPI | 1891170544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY DEACON President 631-495-7762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401406-1) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2015-07-23 |