| NPI | 1548617400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN RUSSELL Owner/Manager 860-993-6347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 006269) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2016-05-20 |