| NPI | 1124569157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE JAMIE STEVENS Owner 203-693-1510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 12.004567) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2025-01-13 |