| NPI | 1114048568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOU GRAHAM Member LLC 860-612-0432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 003146) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |