| NPI | 1598125023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE MARYOTT Clinical Social Worker 203-590-1605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CT 009309) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |