| NPI | 1134399116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL HANSON Clinical Director 860-521-8035 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: CT OPCC 54) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2008-03-06 |