| NPI | 1336588607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCY TALICEO Clinical Director 860-698-6077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 2378) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MA 8146) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2019-06-11 |