| NPI | 1396870101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MARTIN CARLSON Member 860-657-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002229) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |