Provider Demographics
NPI:1891058780
Name:PROCACCINI, JOANNA CELESTE (PSYD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:CELESTE
Last Name:PROCACCINI
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Gender:F
Credentials:PSYD, NCSP
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Mailing Address - Street 1:203 BROAD ST
Mailing Address - Street 2:SUITE C4
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4751
Mailing Address - Country:US
Mailing Address - Phone:203-850-0140
Mailing Address - Fax:888-783-9125
Practice Address - Street 1:203 BROAD ST
Practice Address - Street 2:SUITE C4
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4751
Practice Address - Country:US
Practice Address - Phone:203-850-0140
Practice Address - Fax:888-783-9125
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2015-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT003411103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1891058780Medicaid
CT0400172705Medicare NSC