| NPI | 1396396230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLLE ELIZABETH WARGO Therapist 860-967-4627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2019-09-23 |