| NPI | 1972342046 |
|---|---|
| Doing Business As | FORT HEALTH MEDICAL GROUP OF IL |
| Entity Type | Organization |
| Authorized Contact | TRACI CROSBY Credentialing Manager 201-503-4815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 1041C0700X Social Worker, Clinical | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-10-10 |