| NPI | 1922424175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLAN ELAINE KNOWLDEN Owner 860-966-1787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical | |
| 251S00000X | |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2014-03-12 |