| NPI | 1477583581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | L. KENNETH FELLENBAUM CEO 203-877-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: CT EDT-10) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: CT OPCC-38) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: CT CPA-40) | |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: CT CCF/TS 17) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-08-22 |