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General NPI Number Information
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NPI Number | 1912932344
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Entity Type | Organization
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Legal Business Name | EMMAUS,LLC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 131 SADDLEBROOK PATH
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City | SOUTHINGTON
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State | CT
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Zip | 06489-4423
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Country | US
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Telephone | 860-621-6023
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Fax |
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Provider Business Mailing Address
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Address Line | 131 SADDLEBROOK PATH
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City | SOUTHINGTON
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State | CT
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Zip | 06489-4423
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Country | US
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Telephone | 860-621-6023
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNA MARIE LOPICCOLO
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Credential | MS, LMFT
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Telephone | 860-384-2552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | CT000779
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License Number State | CT
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