NPI | 1942702238 |
---|---|
Entity Type | Organization |
Authorized Contact | ANDREA GODFREY Credentialing & Enrollment Manager 860-788-6404 |
Organization Subpart ? | No |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
2084P0800X Psychiatry & Neurology, Psychiatry | |
2084P0805X Psychiatry & Neurology, Geriatric Psychiatry | |
363L00000X Nurse Practitioner | |
363LP0808X Nurse Practitioner, Psych/Mental Health | |
Enumeration Date | 2018-03-02 |
Last Update Date | 2024-09-04 |