| NPI | 1265099667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE CLEMENTS Manager 860-856-3380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-05-22 |