| NPI | 1588596084 |
|---|---|
| Doing Business As | SEAGLASS |
| Entity Type | Organization |
| Authorized Contact | MARYFRANCES DESTENO Provider 203-918-4488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2026-06-01 |
| Last Update Date | 2026-06-01 |