Provider Demographics
NPI:1043803257
Name:ANN OSOBA LPC LLC
Entity type:Organization
Organization Name:ANN OSOBA LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:OSOBA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-265-8687
Mailing Address - Street 1:10 DALE STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1815
Mailing Address - Country:US
Mailing Address - Phone:860-265-8687
Mailing Address - Fax:
Practice Address - Street 1:10 DALE STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1815
Practice Address - Country:US
Practice Address - Phone:860-265-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12477522OtherCAQH
CT004083672Medicaid