| NPI | 1831110097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE GEYSEN Manager And Member 860-633-0703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 2429) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CT 2429) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-08-22 |