| NPI | 1801477963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA GODFREY Credentialing & Enrollment Manager 860-398-6441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2025-05-05 |