Healthcare Provider Details

I. General information

NPI: 1710848999
Provider Name (Legal Business Name): ONTOGENESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 DAMON RD APT 6106
NORTHAMPTON MA
01060-1863
US

IV. Provider business mailing address

80 DAMON RD APT 6106
NORTHAMPTON MA
01060-1863
US

V. Phone/Fax

Practice location:
  • Phone: 413-800-6242
  • Fax:
Mailing address:
  • Phone: 413-800-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA MICHELLE ABBOTT
Title or Position: OWNER
Credential: LMHC LADAC 1
Phone: 413-800-6242