| NPI | 1306318670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL WALLACE Owner/Psychologist 860-466-9411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2018-12-26 |