NPI | 1831441377 |
---|---|
Entity Type | Organization |
Authorized Contact | MELISA FORMAN Clinical Therapist/Sole Proprietor 860-338-6706 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CT 001617) |
Enumeration Date | 2012-10-08 |
Last Update Date | 2012-10-08 |