| NPI | 1689242810 |
|---|---|
| Doing Business As | CLINICAL THERAPIST |
| Entity Type | Organization |
| Authorized Contact | CHANTAUL SMITH Clinical Director 860-348-5654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-06-23 |