| NPI | 1972857803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JOHN Office Manager 631-486-0026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: NY 226321) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: NY 226321) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |