| NPI | 1972046647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA JELDEN Clinician 860-334-9264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 58.009625) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2016-11-29 |