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