| NPI | 1083110092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA PETIFORD Member 203-445-6238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 006417) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2018-03-30 |