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General NPI Number Information
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NPI Number | 1104254432
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Entity Type | Individual
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Provider Name | AUTUMN OWODUNNI
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Gender | Female
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 265 SLATER ST APT 416
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City | MANCHESTER
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State | CT
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Zip | 06042-8922
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Country | US
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Telephone | 718-207-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MAPLE ST
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City | SPRINGFIELD
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State | MA
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Zip | 01105-1864
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Country | US
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Telephone | 413-732-7419
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Fax | 413-781-1059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6724
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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