| NPI | 1558366757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM RUSH CFO 860-822-4153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CT C-0271) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT C-0271) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 0268) | |
| 101YP2500X Counselor, Professional (Licence: CT C-0271) | |
| 103TC0700X Psychologist, Clinical (Licence: CT C-0271) | |
| 104100000X Social Worker (Licence: CT C-0271) | |
| 106H00000X Marriage & Family Therapist (Licence: CT C-0271) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT C-0271) | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2019-07-03 |