| NPI | 1982201927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY JACKSON Owner 203-819-2025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 171000000X Military Health Care Provider | |
| 225XM0800X Occupational Therapist, Mental Health | |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |