| NPI | 1104149293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY L BENNETT Manager 860-819-8570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 006194) |
| Additional Taxonomies | 251S00000X (Licence: CT 006194) |
| 251S00000X (Licence: CT 000729) | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2012-08-13 |