| NPI | 1629158126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BASSAM AWWA Medical Director 860-437-6914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-11-16 |