| NPI | 1710019963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY P KANABAY Director President 860-456-4604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2014-05-01 |