Organization
INNER PEACE CT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ANN CLARK LCSW (CLINICAL PROGRAM DIRECTOR)
(860) 917-0790
Entity
Organization
Contact information
Practice address
83 BOSTON POST RD, WATERFORD, CT 06385-2423
(860) 917-0790
(860) 443-0748
Mailing address
83 BOSTON POST RD, WATERFORD, CT 06385-2423
(860) 917-0790
(860) 443-0748
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
006060
CT
Other
Enumeration date
03/12/2013
Last updated
03/12/2013
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