| NPI | 1679274039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIZELLE FLORES Credentialing Manager 860-944-4766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 207R00000X Internal Medicine | |
| 207RC0200X Internal Medicine, Critical Care Medicine | |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 261Q00000X Clinic/Center | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2025-02-11 |