| NPI | 1669731360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA M CARROLL Director 860-307-8943 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 005693) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2014-09-29 |