| NPI | 1790330751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE CULLEN Medical Billing Manager 203-368-5515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2019-08-07 |