| NPI | 1619634177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA NICOLE FORST Social Worker 860-901-7916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2023-07-03 |