| NPI | 1962068296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA TROJANOWSKI Provider Enrollment Manager 860-270-0485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist Acute Care |
| 363AM0700X Physician Assistant Medical | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner Adult Health | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor Professional | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TC0700X Psychologist Clinical | |
| 1041C0700X Social Worker Clinical | |
| 207R00000X Internal Medicine | |
| 2083A0300X Preventive Medicine Addiction Medicine | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2025-06-13 |