| NPI | 1114479730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA GODFREY Credentialing & Enrollment Manager 860-788-6404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 1041C0700X Social Worker Clinical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2024-09-04 |