NPI | 1083297089 |
---|---|
Entity Type | Organization |
Authorized Contact | ANDREA GODFREY Credentialing & Enrollment Manager 860-788-6404 |
Organization Subpart ? | No |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 103TC0700X Psychologist, Clinical |
104100000X Social Worker | |
1041C0700X Social Worker, Clinical | |
2084N0400X Psychiatry & Neurology, Neurology | |
2084P0800X Psychiatry & Neurology, Psychiatry | |
363L00000X Nurse Practitioner | |
363LP0808X Nurse Practitioner, Psych/Mental Health | |
Enumeration Date | 2021-04-28 |
Last Update Date | 2024-09-04 |