Provider Demographics
NPI:1215406806
Name:CODERRE, SYDNI NOEL
Entity Type:Individual
Prefix:
First Name:SYDNI
Middle Name:NOEL
Last Name:CODERRE
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 1:33 LYN DR
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9774
Mailing Address - Country:US
Mailing Address - Phone:413-461-8765
Mailing Address - Fax:
Practice Address - Street 1:99A MILL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-1046
Practice Address - Country:US
Practice Address - Phone:177-426-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst