| NPI | 1093277709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE ROACH Billing Administrator 860-368-7092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2019-04-02 |