| NPI | 1932952744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY MARCELLE Clinical Supervisor 631-805-3257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-04-10 |