Healthcare Provider Details

I. General information

NPI: 1447998612
Provider Name (Legal Business Name): SOMEN MAITI LPC ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 431
EUGENE OR
97401-3158
US

IV. Provider business mailing address

132 E BROADWAY STE 431
EUGENE OR
97401-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-390-4559
  • Fax:
Mailing address:
  • Phone: 541-390-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC9367
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: