Provider Demographics
NPI:1083841456
Name:OPROMOLLO, ERICA LEE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEE
Last Name:OPROMOLLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2518
Mailing Address - Country:US
Mailing Address - Phone:860-318-5288
Mailing Address - Fax:
Practice Address - Street 1:35 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795
Practice Address - Country:US
Practice Address - Phone:860-318-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical