| NPI | 1063812527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLE HOLABIRD MACKENZIE Licensed Clinical Social Worker 860-231-7373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: CT 002083) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CT 002083) |
| 1041C0700X Social Worker, Clinical (Licence: CT 002083) | |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2014-11-04 |