| NPI | 1598217614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN DIETERICH Psychologist 203-635-2622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: CT 002826) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CT 002826) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |