Organization
NALEJ OF SELF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JELAN A AGNEW (THERAPIST)
(347) 429-5909
Entity
Organization
Contact information
Practice address
19 ARLINGTON ST, HARTFORD, CT 06106-4004
(347) 429-5909
Mailing address
19 ARLINGTON ST, HARTFORD, CT 06106
(347) 429-5909
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
008581
CT
Other
Enumeration date
11/04/2016
Last updated
11/04/2016
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