| NPI | 1770331761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIZELLE FLORES Credentialing Manager 860-944-4766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2025-03-06 |