| NPI | 1013416585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA GODFREY Credentialing & Enrollment Manager 860-398-6441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0805X | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2025-05-05 |