| NPI | 1376692111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA GRAVES Credentialer 860-442-6364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |