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 |