=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790222784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOANNA OSZMIAN LMFT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2017
-----------------------------------------------------
Last Update Date | 01/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 LAFAYETTE ST
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-306-4535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 SYNAGOGUE RD
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06249-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOANNA OSZMIAN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 860-306-4535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 001828
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------