| NPI | 1982955050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER R BOURQUE Owner 860-990-9870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 5047) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |