| NPI | 1730694316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARUMUNI A. DESILVA Authorized Person 203-988-0766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 101YM0800X Counselor, Mental Health | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical | |
| 103TC1900X Psychologist, Counseling | |
| 207R00000X Internal Medicine | |
| 207R00000X Internal Medicine | |
| 251J00000X Nursing Care | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2019-07-11 |