| NPI | 1295132058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIE A DEE Owner 860-604-8585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401771-1) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2014-11-21 |