| NPI | 1255790143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN LEE President 860-757-3940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001918) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: CT 040517) |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2016-02-19 |