Provider Demographics
NPI:1912932344
Name:EMMAUS,LLC
Entity Type:Organization
Organization Name:EMMAUS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPICCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:860-384-2552
Mailing Address - Street 1:131 SADDLEBROOK PATH
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4423
Mailing Address - Country:US
Mailing Address - Phone:860-621-6023
Mailing Address - Fax:
Practice Address - Street 1:131 SADDLEBROOK PATH
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4423
Practice Address - Country:US
Practice Address - Phone:860-621-6023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004244125Medicaid
CT62-59512OtherUBH PROVIDER NUMBER
CT410000779CT01OtherANTHEM PROVIDER NUMBER