Healthcare Provider Details

I. General information

NPI: 1336175637
Provider Name (Legal Business Name): ANGELA MENTA SNELLING MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WILLOW BROOK FARM RD
OLD SAYBROOK CT
06475-4039
US

IV. Provider business mailing address

4 WILLOW BROOK FARM RD STE 100-189
OLD SAYBROOK CT
06475-4039
US

V. Phone/Fax

Practice location:
  • Phone: 916-390-1211
  • Fax:
Mailing address:
  • Phone: 916-390-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0680136275
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4887
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001376
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12452
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC7838
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: