| NPI | 1396409041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA RODERICK Billing Manager, Access Manager 860-882-6408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2022-06-15 |