| NPI | 1316303019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN DOUGHERTY Owner 860-374-3005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 001019) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2016-01-11 |