| NPI | 1811677149 |
|---|---|
| Doing Business As | SELF EMPLOYED |
| Entity Type | Organization |
| Authorized Contact | EDITH GAULT Clinician 603-387-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2023-07-21 |