| NPI | 1629702519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER B LEE Ap RN 203-927-2191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QP2300X Clinic/Center Primary Care | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2022-07-15 |