| NPI | 1962176404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN BONANNO Owner 860-539-6779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2021-08-08 |
| Last Update Date | 2021-08-08 |