| NPI | 1912179292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT C LONG Fiscal Officer 315-435-3355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2012-09-12 |