| NPI | 1598209116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA L MIGNOSA Owner 203-693-4566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 5763) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 1922) |
| 1041C0700X Social Worker, Clinical (Licence: CT 9481) | |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2016-12-16 |