| NPI | 1063139202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAEDLY POTUSEK Owner 203-536-3161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2022-10-27 |