Provider Demographics
NPI:1790327492
Name:LYNN OBOMALAYAT, LLC
Entity Type:Organization
Organization Name:LYNN OBOMALAYAT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OBOMALAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-281-1771
Mailing Address - Street 1:25 CARDINAL WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3745
Mailing Address - Country:US
Mailing Address - Phone:860-281-1771
Mailing Address - Fax:
Practice Address - Street 1:25 CARDINAL WAY
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3745
Practice Address - Country:US
Practice Address - Phone:860-281-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty