| NPI | 1174476840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN RUSSELL PROVOST Chief Financial Officer 860-683-7153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry |
| Enumeration Date | 2026-02-20 |
| Last Update Date | 2026-02-20 |