| NPI | 1588215156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER HUMPHREY Sole Member 203-217-1455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2019-09-25 |