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General NPI Number Information
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NPI Number | 1689163388
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Entity Type | Organization
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Legal Business Name | OMATA LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 1 FELLOWS RD APT 47
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City | OAKDALE
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State | CT
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Zip | 06370-1624
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Country | US
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Telephone | 860-334-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FELLOWS RD APT 47
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City | OAKDALE
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State | CT
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Zip | 06370-1624
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Country | US
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Telephone | 860-334-5900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MORGAN ANN AJELLO
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Credential | LPC, NCC
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Telephone | 860-334-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 46.003444
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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