| NPI | 1912898289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRA PISTILLO Pmhnp/Provider 346-298-1343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-21 |