| NPI | 1841027653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KING Director 860-322-6712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 1041C0700X Social Worker Clinical | |
| 207Q00000X Family Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2024-09-16 |