| NPI | 1427615053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL KENNETH PAGE Licensed Clinical Social Worker 860-841-2559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-05-20 |