| NPI | 1477999340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS ESTRADA Credentialing Administrator 203-756-8021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: CT 0479) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CT 0506) |
| 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: CT 0474) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2018-02-08 |