| NPI | 1952591851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAIN PATRIE Credentialing Specialist 860-347-6971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 1223G0001X Dentist, General Practice | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 213E00000X Podiatrist | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2012-05-21 |