Provider Demographics
NPI:1174037972
Name:COLETTA, JODY ELAYNE
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:ELAYNE
Last Name:COLETTA
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 1:226 NE SANCHEZ AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-5871
Mailing Address - Country:US
Mailing Address - Phone:352-742-6170
Mailing Address - Fax:
Practice Address - Street 1:226 NE SANCHEZ AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5871
Practice Address - Country:US
Practice Address - Phone:352-742-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical