| NPI | 1245578475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA POWELL Autism Therapist 860-983-8112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 11211741) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: CT 3928518916) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2014-11-08 |