| NPI | 1003496506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA GODFREY Credentialing & Enrollment Manager 860-398-6441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0805X | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2025-05-05 |