| NPI | 1023650090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTNEY JACKSON Member 203-699-6318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2022-01-24 |