| NPI | 1740920859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANI MARTINEZ Outpatient Clinician 860-249-0975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2023-05-24 |