Provider Demographics
NPI:1053539486
Name:LUMIBILITY, INC
Entity type:Organization
Organization Name:LUMIBILITY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-399-1888
Mailing Address - Street 1:1620 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2094
Mailing Address - Country:US
Mailing Address - Phone:860-399-1888
Mailing Address - Fax:860-299-0238
Practice Address - Street 1:1620 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2094
Practice Address - Country:US
Practice Address - Phone:860-399-1888
Practice Address - Fax:860-399-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004186070Medicaid