Provider Demographics
NPI:1386840668
Name:CLODFELTER, CONSTANCE BEATRICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:BEATRICE
Last Name:CLODFELTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 NW 18TH ST
Mailing Address - Street 2:RICHMOND STATE HOSPITAL
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-2851
Mailing Address - Country:US
Mailing Address - Phone:765-935-9312
Mailing Address - Fax:765-935-9512
Practice Address - Street 1:498 NW 18TH ST
Practice Address - Street 2:RICHMOND STATE HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2851
Practice Address - Country:US
Practice Address - Phone:765-935-9312
Practice Address - Fax:765-935-9512
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090177103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist