| NPI | 1841522216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PERRY A STALTARO President 860-502-4908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 2734) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 1998) |
| 1041C0700X Social Worker, Clinical (Licence: CT 4525) | |
| 103G00000X Clinical Neuropsychologist (Licence: CT 2734) | |
| 103TC0700X Psychologist, Clinical (Licence: CT 2883) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 2734) | |
| 103TF0200X Psychologist, Forensic (Licence: CT 2734) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2012-03-19 |