Provider Demographics
NPI:1780574764
Name:CODDING, CONCETTA ROSE
Entity type:Individual
Prefix:
First Name:CONCETTA
Middle Name:ROSE
Last Name:CODDING
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 1:115 MASHENTUCK RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2220
Mailing Address - Country:US
Mailing Address - Phone:860-377-9870
Mailing Address - Fax:
Practice Address - Street 1:115 MASHENTUCK RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2220
Practice Address - Country:US
Practice Address - Phone:860-377-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health