| NPI | 1629428974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA GODFREY Credentialing & Enrollment Manager 860-398-6441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 1041C0700X Social Worker Clinical | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2025-05-05 |