| NPI | 1144561051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA BIREN CAVERLY Psychologist 203-885-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 3248) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CT 3248) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 3248) | |
| 103TF0200X Psychologist, Forensic (Licence: CT 3248) | |
| 103TH0004X Psychologist, Health (Licence: CT 3248) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CT 3248) | |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2015-09-21 |