| NPI | 1316758071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY C CLYNCH Owner/Provider 860-424-2623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2025-01-14 |