Provider Demographics
NPI:1679691265
Name:CADELLA, CONCETTA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:CONCETTA
Middle Name:MARIE
Last Name:CADELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2845
Mailing Address - Country:US
Mailing Address - Phone:203-416-1311
Mailing Address - Fax:203-373-0835
Practice Address - Street 1:238 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2845
Practice Address - Country:US
Practice Address - Phone:203-416-1311
Practice Address - Fax:203-373-0835
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0017591041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid
CT800002377Medicare PIN