| NPI | 1780057653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAILEAH CHRISTIE-FOGG Owner 860-287-6393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 008828) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2016-10-27 |