=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841825320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2020
-----------------------------------------------------
Last Update Date | 03/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 76 W MAIN ST STE 105
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-534-8709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 493
-----------------------------------------------------
City | WEST HYANNISPORT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02672-0493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-487-8295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAELA ELIZA BROWN
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 774-487-8295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------