| NPI | 1588028641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN K WOLD Member 860-595-2890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CT 001744) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CT 001749) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2016-04-05 |