Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003350877 |
---|---|
Provider Name | Jonathan Codraro |
First Address | Plainville, CT 06062-2367 |
Second Address | Plainville, CT 06062-2367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2016 |
Last Update Date | 13/12/2016 |