Healthcare Provider Details

I. General information

NPI: 1093323537
Provider Name (Legal Business Name): UJIMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 MAIN ST
PLYMOUTH CT
06782-2246
US

IV. Provider business mailing address

768 MAIN ST
PLYMOUTH CT
06782-2246
US

V. Phone/Fax

Practice location:
  • Phone: 860-792-1124
  • Fax:
Mailing address:
  • Phone: 860-792-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LETTICIA BROWN-GAMBINO
Title or Position: PRINCIPAL
Credential: MS, NCC, LPC
Phone: 860-792-1124