| NPI | 1295564425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES GRANVILLE MARTIN General Counsel 860-494-5884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-07-27 |
| Last Update Date | 2026-04-10 |