| NPI | 1003574245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY BERGERON Licensed Clinical Social Worker 203-307-0119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2021-12-06 |