Provider Demographics
NPI:1619695632
Name:NOEL, CODASHA FLORE RAYMOND
Entity Type:Individual
Prefix:MS
First Name:CODASHA
Middle Name:FLORE RAYMOND
Last Name:NOEL
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 1:4002 INVERRARY BLVD APT 2B
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4371
Mailing Address - Country:US
Mailing Address - Phone:813-638-1857
Mailing Address - Fax:
Practice Address - Street 1:3720 COCONUT CREEK PKWY STE D
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1634
Practice Address - Country:US
Practice Address - Phone:954-590-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-225229106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician