| NPI | 1205313947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORYE EMORY JACKSON Lcsw 203-979-3503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CT 008194) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2018-07-25 |