| NPI | 1255548590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JOHNSON Credentialing Coordinator 860-510-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |