| Lynn Obomalayat, Llc | |
|
25 Cardinal Way South Windsor CT 06074-3745 | |
| (860) 281-1771 | |
| Not Available |
| Full Name | Lynn Obomalayat, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 25 Cardinal Way, South Windsor, Connecticut |
| Authorized Official Name and Position | Lynn Marie Obomalayat (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 8602811771 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lynn Obomalayat, Llc 25 Cardinal Way South Windsor CT 06074-3745 Ph: (860) 281-1771 | Lynn Obomalayat, Llc 25 Cardinal Way South Windsor CT 06074-3745 Ph: (860) 281-1771 |
| NPI Number | 1790327492 |
|---|---|
| Provider Enumeration Date | 10/14/2019 |
| Last Update Date | 04/26/2021 |
| Certification Date | 04/26/2021 |
| Medicare PECOS PAC ID | 9931539145 |
|---|---|
| Medicare Enrollment ID | O20200430000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790327492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Lynn Marie Obomalayat |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073162947 PECOS PAC ID: 0840620050 Enrollment ID: I20200430000436 |
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