| NPI | 1629810585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER RALPH BOURQUE Owner 860-960-6675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2024-10-03 |