| NPI | 1891328373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BRADLEY GARDNER Licensed Clinical Social Worker 860-374-3119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2020-02-12 |