=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831458389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUMINITA VATASOIU MA, LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2012
-----------------------------------------------------
Last Update Date | 01/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 OLD CHARTER RD
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-2323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-254-0892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 OLD CHARTER RD
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-2323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 10415
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------