| NPI | 1922710094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN SPRAGUE-LEE Owner/Authorized Official 848-236-7344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| 104100000X Social Worker | |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2023-01-31 |