| NPI | 1982645669 |
|---|---|
| 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 | 1041C0700X Social Worker, Clinical (Licence: CT 0394) |
| 103TC0700X Psychologist, Clinical (Licence: CT 0394) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT OPCC23) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 0394) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT OPCC23) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2007-07-16 |