| NPI | 1922470426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA VAZQUEZ Substance Abuse Counselor 718-292-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |